Provider Demographics
NPI:1679117956
Name:PRESTIGE DENTAL CORPORATION
Entity Type:Organization
Organization Name:PRESTIGE DENTAL CORPORATION
Other - Org Name:SOUTHBAY DENTAL CENTER II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:Q
Authorized Official - Last Name:VIRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-453-9800
Mailing Address - Street 1:1728 HOSTETTER RD STE 60
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-3312
Mailing Address - Country:US
Mailing Address - Phone:408-453-9800
Mailing Address - Fax:408-453-9804
Practice Address - Street 1:3535 CALLAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5118
Practice Address - Country:US
Practice Address - Phone:650-623-5088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty