Provider Demographics
NPI:1134256969
Name:UNIVERSITY OF THE PACIFIC ARTHUR A. DUGONI SCHOOL OF DENTISTRY
Entity type:Organization
Organization Name:UNIVERSITY OF THE PACIFIC ARTHUR A. DUGONI SCHOOL OF DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST DEAN, BUDGET & FIN ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGUEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-351-7192
Mailing Address - Street 1:155 5TH ST STE 2F
Mailing Address - Street 2:HOSPITAL DENTISTRY SPECIAL CARE CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2919
Mailing Address - Country:US
Mailing Address - Phone:415-929-6617
Mailing Address - Fax:415-929-6654
Practice Address - Street 1:155 5TH ST STE 2F
Practice Address - Street 2:HOSPITAL DENTISTRY SPECIAL CARE CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2919
Practice Address - Country:US
Practice Address - Phone:415-929-6617
Practice Address - Fax:415-929-6654
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF THE PACIFIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
CA1223G0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG01001-04OtherDENTI-CAL IDENTIFICATION