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General NPI Number Information
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NPI Number | 1861082836
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Entity Type | Organization
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Legal Business Name | SAN PABLO DENTAL MANAGEMENT INC
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 11100 SAN PABLO AVE
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City | EL CERRITO
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State | CA
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Zip | 94530-2194
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Country | US
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Telephone | 510-233-9022
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Fax |
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Provider Business Mailing Address
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Address Line | 11100 SAN PABLO AVE
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City | EL CERRITO
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State | CA
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Zip | 94530-2194
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Country | US
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Telephone | 510-233-9022
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JEREMIE RESPICIO
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Credential |
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Telephone | 415-301-9450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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