Provider Demographics
NPI:1609023779
Name:H STREET DENTISTRY
Entity Type:Organization
Organization Name:H STREET DENTISTRY
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:KWOK-LIANG
Authorized Official - Last Name:AU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-631-1113
Mailing Address - Street 1:2007 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4203
Mailing Address - Country:US
Mailing Address - Phone:661-631-1113
Mailing Address - Fax:661-631-1116
Practice Address - Street 1:2007 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4203
Practice Address - Country:US
Practice Address - Phone:661-631-1113
Practice Address - Fax:661-631-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA344631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA34463OtherCALIFORNIA STATE LICENSE