Provider Demographics
NPI:1336242718
Name:BOOTH & WILLIAMS DENTAL CORP
Entity Type:Organization
Organization Name:BOOTH & WILLIAMS DENTAL CORP
Other - Org Name:UPTOWN DENTAL DESIGNS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-546-0488
Mailing Address - Street 1:3703 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-546-0488
Mailing Address - Fax:619-795-3419
Practice Address - Street 1:3703 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-546-0488
Practice Address - Fax:619-795-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34933122300000X
CA23400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty