Provider Demographics
NPI:1043556699
Name:US FAMILY DENTAL
Entity Type:Organization
Organization Name:US FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:ROSHINI
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-441-2222
Mailing Address - Street 1:1320 DECOTO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3599
Mailing Address - Country:US
Mailing Address - Phone:510-441-2222
Mailing Address - Fax:
Practice Address - Street 1:1320 DECOTO RD STE 100
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3599
Practice Address - Country:US
Practice Address - Phone:510-441-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55292305R00000X
CA49569305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization