Provider Demographics
NPI:1043418106
Name:RENATO C CALIP DMD
Entity Type:Organization
Organization Name:RENATO C CALIP DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:CABASAAN
Authorized Official - Last Name:CALIP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-994-3836
Mailing Address - Street 1:2386 JUNIPERO SERRA BLVD
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1647
Mailing Address - Country:US
Mailing Address - Phone:650-994-3836
Mailing Address - Fax:650-994-0612
Practice Address - Street 1:2386 JUNIPERO SERRA BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1647
Practice Address - Country:US
Practice Address - Phone:650-994-3836
Practice Address - Fax:650-994-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA037087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty