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General NPI Number Information
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NPI Number | 1659725240
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Entity Type | Organization
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Legal Business Name | BANCROFT DENTAL CARE
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 04/20/2016
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Provider Practice Location Address
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Address Line | 680 BANCROFT AVE
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City | SAN LEANDRO
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State | CA
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Zip | 94577-2904
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Country | US
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Telephone | 510-569-0218
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Fax |
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Provider Business Mailing Address
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Address Line | 680 BANCROFT AVE
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City | SAN LEANDRO
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State | CA
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Zip | 94577-2904
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Country | US
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Telephone |
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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. PARASITE GEHLE
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Credential | DMD
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Telephone | 510-569-0218
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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 | 58828
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License Number State | CA
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