MEDICARE: UCSF CENTER FOR OROFACIAL PAIN

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

General Provider Information

NPI Number	:	1275612194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UCSF CENTER FOR OROFACIAL PAIN

Provider Business Mailing Address
First Line	:	707 PARNASSUS AVE
Second Line	:	BOX 0768
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2210
Country	:	US
Telephone Number	:	415-476-8298
Fax Number	:	415-502-6489

Provider Business Practice Location Address
First Line	:	707 PARNASSUS AVE
Second Line	:	BOX 0768
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2210
Country	:	US
Telephone Number	:	415-476-8298
Fax Number	:	415-502-6489

Authorized Official
Title or Position	:	DEAN
Name	:	DR. CHARLES N BERTOLAMI
Credential	:	D.D.S
Telephone Number	:	415-476-8997

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	08/22/2020

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Directions to “UCSF CENTER FOR OROFACIAL PAIN ” Practice Location

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