Provider Demographics
NPI:1003278995
Name:PRIES DENTAL CARE
Entity type:Organization
Organization Name:PRIES DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KOSTANTIONS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-260-0200
Mailing Address - Street 1:4110 MOORPARK AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1712
Mailing Address - Country:US
Mailing Address - Phone:408-260-0200
Mailing Address - Fax:408-625-4725
Practice Address - Street 1:4110 MOORPARK AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1712
Practice Address - Country:US
Practice Address - Phone:408-260-0200
Practice Address - Fax:408-625-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty