Provider Demographics
NPI:1972977510
Name:PERSIMMON DENTAL CARE
Entity Type:Organization
Organization Name:PERSIMMON DENTAL CARE
Other - Org Name:PERSIMMON DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:925-999-8282
Mailing Address - Street 1:5281 MARTINELLI WAY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7136
Mailing Address - Country:US
Mailing Address - Phone:925-999-8282
Mailing Address - Fax:
Practice Address - Street 1:5281 MARTINELLI WAY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7136
Practice Address - Country:US
Practice Address - Phone:925-999-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty