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General NPI Number Information
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NPI Number | 1922510189
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Entity Type | Organization
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Legal Business Name | ANTIPOV DENTAL INC
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Dates
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Enumeration Date | 10/27/2017
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 490 POST ST STE 1022
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-1301
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Country | US
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Telephone | 415-800-7594
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Fax | 415-800-7969
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Provider Business Mailing Address
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Address Line | 490 POST ST STE 1022
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-1301
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Country | US
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Telephone | 415-800-7594
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Fax | 415-800-7969
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Authorized Official
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Title or Position | DOCTOR
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Name | OLGA ANTIPOVA
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Credential |
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Telephone | 415-800-7594
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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 | 61522
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License Number State | CA
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