MEDICARE: TOLOSA SISON PROF. DENTAL CORP.

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	1223G0001X	General Practice Dentistry		CA

General Provider Information

NPI Number	:	1821163759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOLOSA SISON PROF. DENTAL CORP.

Provider Business Mailing Address
First Line	:	5061 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-3417
Country	:	US
Telephone Number	:	141-558-7116
Fax Number	:	415-587-1163

Provider Business Practice Location Address
First Line	:	5061 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-3417
Country	:	US
Telephone Number	:	141-558-7116
Fax Number	:	415-587-1163

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MARIA AGNES T SISON
Credential	:	D.M.D
Telephone Number	:	415-587-1161

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	08/22/2020

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