Provider Demographics
NPI:1508294927
Name:UNIVERSITY OF THE PACIFIC
Entity Type:Organization
Organization Name:UNIVERSITY OF THE PACIFIC
Other - Org Name:ARTHUR A. DUGONI SCHOOL OF DENTISTRY OMFS CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOC DEAN, BUDGET & FIN ADMIN, AO
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGUEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-351-7192
Mailing Address - Street 1:155 5TH ST STE 3F
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2919
Mailing Address - Country:US
Mailing Address - Phone:415-929-6617
Mailing Address - Fax:415-794-3305
Practice Address - Street 1:155 5TH ST
Practice Address - Street 2:OFMSC SUITE 3F
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2919
Practice Address - Country:US
Practice Address - Phone:415-929-6617
Practice Address - Fax:415-794-3305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF THE PACIFIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-22
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223S0112X
261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial SurgeryGroup - Single Specialty