Provider Demographics
NPI:1376087882
Name:GILA C. DOROSTKAR, DDS, PC
Entity Type:Organization
Organization Name:GILA C. DOROSTKAR, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-461-0414
Mailing Address - Street 1:1300 S ELISEO DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2023
Mailing Address - Country:US
Mailing Address - Phone:415-461-0414
Mailing Address - Fax:416-461-0431
Practice Address - Street 1:1300 S ELISEO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2023
Practice Address - Country:US
Practice Address - Phone:415-461-0414
Practice Address - Fax:416-461-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty