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General NPI Number Information
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NPI Number | 1376087882
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Entity Type | Organization
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Legal Business Name | GILA C. DOROSTKAR, DDS, PC
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 1300 S ELISEO DR SUITE 100
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City | GREENBRAE
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State | CA
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Zip | 94904-2023
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Country | US
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Telephone | 415-461-0414
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Fax | 416-461-0431
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Provider Business Mailing Address
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Address Line | 1300 S ELISEO DR SUITE 100
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City | GREENBRAE
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State | CA
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Zip | 94904-2023
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Country | US
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Telephone | 415-461-0414
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Fax | 416-461-0431
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Authorized Official
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Title or Position | EXECUTIVE MANAGER
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Name | MS. DEBORAH COLEY
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Credential |
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Telephone | 415-461-0414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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