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General NPI Number Information
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NPI Number | 1598781221
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Entity Type | Organization
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Legal Business Name | BAY DENTAL ASSOCIATES
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 12/16/2008
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Provider Practice Location Address
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Address Line | 320 N SAN MATEO DR # 2
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City | SAN MATEO
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State | CA
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Zip | 94401-2514
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Country | US
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Telephone | 650-344-1844
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Fax |
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Provider Business Mailing Address
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Address Line | 78 N ELLSWORTH AVE
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City | SAN MATEO
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State | CA
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Zip | 94401-2820
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Country | US
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Telephone | 650-344-1845
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DORIS NISHIMOTO
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Credential | D.D.S.
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Telephone | 650-344-1844
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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 | 27549
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License Number State | CA
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