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General NPI Number Information
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NPI Number | 1730679747
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Entity Type | Organization
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Legal Business Name | FOLSOM DENTAL GROUP
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 3085 24TH ST STE 202
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-4147
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Country | US
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Telephone | 415-525-3371
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Fax |
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Provider Business Mailing Address
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Address Line | 3085 24TH ST STE 202
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-4147
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Country | US
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Telephone | 415-525-3371
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | BRAULIO ULLOA
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Credential | DDS
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Telephone | 415-400-5115
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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 | 100311
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 101455
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47673
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License Number State | CA
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