Provider Demographics
NPI:1063846533
Name:SAN CARLOS ENDODONTICS
Entity Type:Organization
Organization Name:SAN CARLOS ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALDASSARI-CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-380-1337
Mailing Address - Street 1:405 EL CAMINO REAL
Mailing Address - Street 2:#622
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-5240
Mailing Address - Country:US
Mailing Address - Phone:650-595-3722
Mailing Address - Fax:650-595-3636
Practice Address - Street 1:1028 LAUREL ST
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3919
Practice Address - Country:US
Practice Address - Phone:650-595-3722
Practice Address - Fax:650-595-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38395261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental