Provider Demographics
NPI:1093880353
Name:UCSF DIVISION OF ORTHODONTICS
Entity Type:Organization
Organization Name:UCSF DIVISION OF ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN SCHOOL OF DENTISTRY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:N
Authorized Official - Last Name:BERTOLAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-476-1323
Mailing Address - Street 1:707 PARNASSUS AVE BOX 0438
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0438
Mailing Address - Country:US
Mailing Address - Phone:415-502-6707
Mailing Address - Fax:415-514-0377
Practice Address - Street 1:707 PARNASSUS AVE BOX 0438
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0438
Practice Address - Country:US
Practice Address - Phone:415-502-6707
Practice Address - Fax:415-514-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG02003-01OtherDENTI-CAL PROVIDER #
CA2003OtherDELTA DENTAL PROVIDER #
CACGP166827OtherCALIFORNIA CHILDRENS SERV