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General NPI Number Information
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NPI Number | 1386902658
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Entity Type | Individual
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Provider Name | AI B. STREACKER DDS
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Gender | Male
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 2155 WEBSTER ST C 29
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-2333
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Country | US
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Telephone | 415-929-6613
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Fax |
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Provider Business Mailing Address
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Address Line | 2155 WEBSTER ST SUITE C 29
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City | SAN FRANCISCO
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State | CALIFORNIA
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Zip | 94115
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Country | UM
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Telephone | 415-517-8643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 28392
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License Number State | CA
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