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General NPI Number Information
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NPI Number | 1912523234
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Entity Type | Organization
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Legal Business Name | SANNA CHARLIE DDS PC
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 60 FENTON ST STE 10
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City | LIVERMORE
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State | CA
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Zip | 94550-4148
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Country | US
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Telephone | 925-447-8635
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2812
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City | DUBLIN
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State | CA
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Zip | 94568-0812
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | DR. SANNA CHARLIE
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Credential | DDS
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Telephone | 925-895-5268
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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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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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