Provider Demographics
NPI:1194186999
Name:UNIVERSITY OF THE PACIFIC
Entity Type:Organization
Organization Name:UNIVERSITY OF THE PACIFIC
Other - Org Name:DUGONI SCHOOL OF DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:NADERSHAHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-929-6400
Mailing Address - Street 1:142 ALHAMBRA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2004
Mailing Address - Country:US
Mailing Address - Phone:415-614-2612
Mailing Address - Fax:415-614-2612
Practice Address - Street 1:142 ALHAMBRA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-2004
Practice Address - Country:US
Practice Address - Phone:415-614-2612
Practice Address - Fax:415-614-2612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF THE PACIFIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15309261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15309OtherSTATE LICENSE NUMBER
CA15309OtherCALIFORNIA DENTAL LICENSE