Provider Demographics
NPI:1629565338
Name:ON-SITE DENTAL CARE FOUNDATION, INC
Entity Type:Organization
Organization Name:ON-SITE DENTAL CARE FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:MARTINE
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-315-4864
Mailing Address - Street 1:PO BOX 41111
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95160-1111
Mailing Address - Country:US
Mailing Address - Phone:408-315-4864
Mailing Address - Fax:408-608-2205
Practice Address - Street 1:3180 NEWBERRY DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1566
Practice Address - Country:US
Practice Address - Phone:408-315-4864
Practice Address - Fax:408-608-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty