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General NPI Number Information
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NPI Number | 1689894198
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Entity Type | Organization
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Legal Business Name | R. GLENN KITASOE,DDS,INC.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 825 OAK GROVE AVE
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City | MENLO PARK
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State | CA
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Zip | 94025-4434
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Country | US
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Telephone | 650-323-5211
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Fax |
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Provider Business Mailing Address
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Address Line | 825 OAK GROVE AVE
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City | MENLO PARK
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State | CA
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Zip | 94025-4434
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Country | US
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Telephone | 650-323-5211
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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. R. GLENN KITASOE
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Credential | DDS
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Telephone | 650-323-5211
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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 | 29329
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License Number State | CA
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