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General NPI Number Information
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NPI Number | 1801290416
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Entity Type | Organization
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Legal Business Name | HILADO SUNNYVALE DENTAL GROUP, INC.
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Dates
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Enumeration Date | 10/11/2014
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Last Update Date | 10/11/2014
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Provider Practice Location Address
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Address Line | 990 W FREMONT AVE SUITE L
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City | SUNNYVALE
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State | CA
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Zip | 94087-3021
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Country | US
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Telephone | 408-739-9050
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Fax | 408-739-8028
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Provider Business Mailing Address
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Address Line | 990 W FREMONT AVE SUITE L
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City | SUNNYVALE
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State | CA
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Zip | 94087-3021
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Country | US
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Telephone | 408-739-9050
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Fax | 408-739-8028
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Authorized Official
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Title or Position | CFO,VP, PARTNER
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Name | MS. LYNN PATRICE SANTOS
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Credential | R.D.H.
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Telephone | 408-593-5999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 13976
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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 | 53601
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License Number State | CA
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