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General NPI Number Information
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NPI Number | 1538713086
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Entity Type | Organization
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Legal Business Name | NEWARK SQUARE DENTAL CARE INC
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 5678 THORNTON AVE.
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City | NEWARK
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State | CA
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Zip | 94560
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Country | US
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Telephone | 510-894-1556
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Fax | 650-968-6299
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Provider Business Mailing Address
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Address Line | 5678 THORNTON AVE.
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City | NEWARK
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State | CA
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Zip | 94560
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Country | US
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Telephone | 510-894-1556
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Fax | 650-968-6299
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SUSAN P. GALVAN
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Credential |
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Telephone | 408-627-1628
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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 |
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License Number State |
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