Provider Demographics
NPI:1023777539
Name:CALIFORNIA INTEGRATED DENTISTRY
Entity type:Organization
Organization Name:CALIFORNIA INTEGRATED DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOD
Authorized Official - Prefix:
Authorized Official - First Name:KIYOSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MRS
Authorized Official - Phone:254-550-3280
Mailing Address - Street 1:2066 N CAPITOL AVE # 1169
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-1015
Mailing Address - Country:US
Mailing Address - Phone:254-550-3280
Mailing Address - Fax:
Practice Address - Street 1:2066 N CAPITOL AVE # 1169
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-1015
Practice Address - Country:US
Practice Address - Phone:254-550-3280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-12
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty