Provider Demographics
NPI:1588013593
Name:JULIAN ALIVIA DDS INC
Entity Type:Organization
Organization Name:JULIAN ALIVIA DDS INC
Other - Org Name:BERNAL HEIGHTS SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIVIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-641-8900
Mailing Address - Street 1:3208 MISSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-7606
Mailing Address - Country:US
Mailing Address - Phone:415-641-8900
Mailing Address - Fax:415-641-1191
Practice Address - Street 1:3208 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5007
Practice Address - Country:US
Practice Address - Phone:415-641-8900
Practice Address - Fax:415-641-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64772261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental