Provider Demographics
NPI:1790101749
Name:REGENTS OF THE UNIVERSITY OF CA UCSF ADVANCED EDU GEN DENTIST
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CA UCSF ADVANCED EDU GEN DENTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-476-2055
Mailing Address - Street 1:707 PARNASSUS AVE
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2210
Mailing Address - Country:US
Mailing Address - Phone:415-476-3028
Mailing Address - Fax:415-502-8399
Practice Address - Street 1:707 PARNASSUS AVE
Practice Address - Street 2:SUITE 4000
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2210
Practice Address - Country:US
Practice Address - Phone:415-476-3028
Practice Address - Fax:415-502-8399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty