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General NPI Number Information
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NPI Number | 1902008568
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Entity Type | Individual
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Provider Name | MICHAEL LUKE VISTA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4972 MISSION ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94112-3416
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Country | US
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Telephone | 415-333-3400
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Fax | 415-333-3400
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Provider Business Mailing Address
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Address Line | 1950 SPYGLASS DR
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City | SAN BRUNO
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State | CA
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Zip | 94066-1048
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Country | US
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Telephone | 650-355-7230
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 54444
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License Number State | CA
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