Provider Demographics
NPI:1760599765
Name:UY, GLORIA FARNE (DMD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:FARNE
Last Name:UY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ALFRED NOBEL DR
Mailing Address - Street 2:SUITE 265
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1838
Mailing Address - Country:US
Mailing Address - Phone:510-724-4678
Mailing Address - Fax:510-724-4676
Practice Address - Street 1:500 ALFRED NOBEL DR
Practice Address - Street 2:SUITE 265
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1838
Practice Address - Country:US
Practice Address - Phone:510-724-4678
Practice Address - Fax:510-724-4676
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB26291Medicaid
CA26291OtherLICENSE
247918Medicare UPIN