MEDICARE: DR. NATALIE GORMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	110361	CA

General Provider Information

NPI Number	:	1255165890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALIE GORMAN DDS

Provider Business Mailing Address
First Line	:	1606 JUANITA LN
Second Line	:
City	:	TIBURON
State	:	CA
Zip	:	94920-2548
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 UNION ST STE 450
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4137
Country	:	US
Telephone Number	:	415-922-2992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	12/18/2024

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