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General NPI Number Information
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NPI Number | 1942869961
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Entity Type | Organization
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Legal Business Name | UCSF SCHOOL OF DENTISTRY CLINIC NO. 1
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 707 PARNASSUS AVE # D-2000
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City | SAN FRANCISCO
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State | CA
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Zip | 94143-2210
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Country | US
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Telephone | 415-476-5747
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Fax | 415-476-6110
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Provider Business Mailing Address
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Address Line | 707 PARNASSUS AVENUE D1130 BOX 0752
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City | SAN FRANCISCO
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State | CA
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Zip | 94143-2210
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Country | US
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Telephone | 415-476-5747
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Fax | 415-476-6110
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Authorized Official
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Title or Position | DEAN, SCHOOL OF DENTISTRY
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Name | DR. MICHAEL REDDY
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Credential | DMD, DMSC
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Telephone | 415-476-1323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #3
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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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