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General NPI Number Information
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NPI Number | 1942122726
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Entity Type | Organization
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Legal Business Name | HYATT SUBIDO DENTAL GROUP, INC, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/27/2026
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Last Update Date | 07/27/2026
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Provider Practice Location Address
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Address Line | 428 MAGNOLIA AVE
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City | LARKSPUR
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State | CA
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Zip | 94939-2035
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Country | US
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Telephone | 415-924-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 428 MAGNOLIA AVE
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City | LARKSPUR
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State | CA
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Zip | 94939-2035
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Country | US
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Telephone | 415-924-7900
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Fax |
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Authorized Official
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Title or Position | C.E.O./PRESIDENT
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Name | DR. ANDREW SUBIDO
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Credential | D.D.S.
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Telephone | 415-205-2402
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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 |
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License Number State |
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