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General NPI Number Information
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NPI Number | 1881138303
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Entity Type | Organization
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Legal Business Name | G.C. DOROSTKAR, DDS,PC
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 650 E BLITHEDALE AVE SUITE C
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City | MILL VALLEY
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State | CA
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Zip | 94941-1478
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Country | US
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Telephone | 415-461-0414
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Fax |
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Provider Business Mailing Address
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Address Line | 650 E BLITHEDALE AVE SUITE C
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City | MILL VALLEY
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State | CA
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Zip | 94941-1478
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Country | US
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Telephone | 415-461-0414
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE MANAGER
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Name | MS. DEBORAH COLEY
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Credential |
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Telephone | 415-461-0414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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