Provider Demographics
NPI:1881138303
Name:G.C. DOROSTKAR, DDS,PC
Entity type:Organization
Organization Name:G.C. DOROSTKAR, DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-461-0414
Mailing Address - Street 1:650 E BLITHEDALE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1478
Mailing Address - Country:US
Mailing Address - Phone:415-461-0414
Mailing Address - Fax:
Practice Address - Street 1:650 E BLITHEDALE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1478
Practice Address - Country:US
Practice Address - Phone:415-461-0414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty