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General NPI Number Information
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NPI Number | 1396121828
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Entity Type | Organization
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Legal Business Name | OAKLAND ECO DENTAL
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 2838 SUMMIT ST
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City | OAKLAND
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State | CA
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Zip | 94609-3605
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Country | US
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Telephone | 510-465-2838
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Fax |
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Provider Business Mailing Address
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Address Line | 2838 SUMMIT ST
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City | OAKLAND
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State | CA
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Zip | 94609-3605
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Country | US
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Telephone | 510-465-2838
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. KIMBERLY JEANNE BUTLER
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Credential | DDS
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Telephone | 510-465-2838
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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 | 64928
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License Number State | CA
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