=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538256250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FINN H. TONSBERG, D.D.S., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1907 SANTA CLARA AVE
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94501-2633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-523-6400
-----------------------------------------------------
Fax | 510-523-2315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1907 SANTA CLARA AVE
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94501-2633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-523-6400
-----------------------------------------------------
Fax | 510-523-2315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/ DENTIST
-----------------------------------------------------
Name | DR. FINN HALVOR TONSBERG
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 510-523-6400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 22926
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------