Provider Demographics
NPI:1083600365
Name:MCBRIDE & WITTENBERG, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:MCBRIDE & WITTENBERG, A DENTAL CORPORATION
Other - Org Name:SAN BENITO ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-636-9808
Mailing Address - Street 1:890 SUNSET DR
Mailing Address - Street 2:SUITE B-1A
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5651
Mailing Address - Country:US
Mailing Address - Phone:831-636-9808
Mailing Address - Fax:831-636-9843
Practice Address - Street 1:890 SUNSET DR
Practice Address - Street 2:SUITE B-1A
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5651
Practice Address - Country:US
Practice Address - Phone:831-636-9808
Practice Address - Fax:831-636-9843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty