Provider Demographics
NPI: | 1164047668 |
---|---|
Name: | TODOR STAVREV DDS MS INC |
Entity Type: | Organization |
Organization Name: | TODOR STAVREV DDS MS INC |
Other - Org Name: | TODORTHODONTICS SMILE STUDIO |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | ORTHODONTIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | TODOR |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | STAVREV |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS, MS |
Authorized Official - Phone: | 415-399-9200 |
Mailing Address - Street 1: | 260 STOCKTON ST FL 3 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN FRANCISCO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94108-5314 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 415-399-9200 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 260 STOCKTON ST FL 3 |
Practice Address - Street 2: | |
Practice Address - City: | SAN FRANCISCO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94108-5314 |
Practice Address - Country: | US |
Practice Address - Phone: | 415-399-9200 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-06-10 |
Last Update Date: | 2021-07-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223X0400X | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | Group - Single Specialty |