Provider Demographics
NPI:1821163759
Name:TOLOSA SISON PROF. DENTAL CORP.
Entity Type:Organization
Organization Name:TOLOSA SISON PROF. DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA AGNES
Authorized Official - Middle Name:T
Authorized Official - Last Name:SISON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:415-587-1161
Mailing Address - Street 1:5061 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3417
Mailing Address - Country:US
Mailing Address - Phone:141-558-7116
Mailing Address - Fax:415-587-1163
Practice Address - Street 1:5061 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3417
Practice Address - Country:US
Practice Address - Phone:141-558-7116
Practice Address - Fax:415-587-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty