Provider Demographics
NPI:1801290416
Name:HILADO SUNNYVALE DENTAL GROUP, INC.
Entity type:Organization
Organization Name:HILADO SUNNYVALE DENTAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO,VP, PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:408-593-5999
Mailing Address - Street 1:990 W FREMONT AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3021
Mailing Address - Country:US
Mailing Address - Phone:408-739-9050
Mailing Address - Fax:408-739-8028
Practice Address - Street 1:990 W FREMONT AVE
Practice Address - Street 2:SUITE L
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3021
Practice Address - Country:US
Practice Address - Phone:408-739-9050
Practice Address - Fax:408-739-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-11
Last Update Date:2014-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13976124Q00000X
CA536011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty