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General NPI Number Information
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NPI Number | 1942774989
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Entity Type | Organization
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Legal Business Name | HERCULES DENTAL CARE IN FREMONT
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Dates
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Enumeration Date | 01/13/2019
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Last Update Date | 01/13/2019
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Provider Practice Location Address
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Address Line | 556 MOWRY AVE STE 203
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City | FREMONT
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State | CA
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Zip | 94536-4186
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Country | US
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Telephone | 510-791-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 500 ALFRED NOBEL DR STE 130
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City | HERCULES
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State | CA
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Zip | 94547-1839
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Country | US
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Telephone | 510-741-1777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS C LIN
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Credential | DDS
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Telephone | 510-741-1777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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