Provider Demographics
NPI:1114006061
Name:UCSF FACULTY GRP DENT PRACT & GRAD PROSTHODONTICS CL3
Entity Type:Organization
Organization Name:UCSF FACULTY GRP DENT PRACT & GRAD PROSTHODONTICS CL3
Other - Org Name:UCSF PROSTHODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:DEAN, SCHOOL OF DENTISTRY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-476-9135
Mailing Address - Street 1:707 PARNASSUS AVE
Mailing Address - Street 2:D4000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0758
Mailing Address - Country:US
Mailing Address - Phone:415-476-1784
Mailing Address - Fax:415-514-3180
Practice Address - Street 1:707 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0752
Practice Address - Country:US
Practice Address - Phone:415-502-7320
Practice Address - Fax:415-514-3180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZP3827ZMedicare PIN
CAU17277Medicare UPIN