Provider Demographics
NPI:1912375510
Name:UCSF ORAL SURGERY CL. #20-3
Entity Type:Organization
Organization Name:UCSF ORAL SURGERY CL. #20-3
Other - Org Name:UCSF OROFACIAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:INTERIM DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEATHERSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-476-8997
Mailing Address - Street 1:707 PARNASSUS AVE
Mailing Address - Street 2:BOX 0756
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2210
Mailing Address - Country:US
Mailing Address - Phone:415-476-1316
Mailing Address - Fax:415-476-8999
Practice Address - Street 1:707 PARNASSUS AVE
Practice Address - Street 2:D1201
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2210
Practice Address - Country:US
Practice Address - Phone:415-476-1316
Practice Address - Fax:415-476-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0041992Medicaid
CAGR0041992Medicaid