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General NPI Number Information
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NPI Number | 1427177815
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Entity Type | Organization
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Legal Business Name | FOOTHILL DENTAL CARE
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 881 FREMONT AVE STE B1
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City | LOS ALTOS
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State | CA
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Zip | 94024-5637
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Country | US
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Telephone | 650-949-4734
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Fax |
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Provider Business Mailing Address
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Address Line | 881 FREMONT AVE STE B1
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City | LOS ALTOS
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State | CA
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Zip | 94024-5637
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Country | US
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Telephone | 650-949-4734
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SUSAN EZZATI
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Credential | DDS
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Telephone | 650-949-4734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 35491
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 37544
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License Number State | CA
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