Provider Demographics
NPI:1437286077
Name:UNVIERSITY OF THE PACIFIC ARTHUR A. DUGONI SCHOOL OF DENTISTRY
Entity Type:Organization
Organization Name:UNVIERSITY OF THE PACIFIC ARTHUR A. DUGONI SCHOOL OF DENTISTRY
Other - Org Name:LAGUNA HONDA
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE DEAN FOR CLINICAL SERVICE
Authorized Official - Prefix:DR
Authorized Official - First Name:SIGMUND
Authorized Official - Middle Name:
Authorized Official - Last Name:ABELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-929-6604
Mailing Address - Street 1:375 LAGUNA HONDA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1411
Mailing Address - Country:US
Mailing Address - Phone:415-759-4604
Mailing Address - Fax:
Practice Address - Street 1:375 LAGUNA HONDA BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1411
Practice Address - Country:US
Practice Address - Phone:415-759-4604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF THE PACIFIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG01001-08OtherDENTI-CAL IDENTIFICATION