Provider Demographics
NPI:1912123027
Name:MA, MICHAEL TC (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TC
Last Name:MA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 CALIFORNIA ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1380
Mailing Address - Country:US
Mailing Address - Phone:415-386-1314
Mailing Address - Fax:
Practice Address - Street 1:4216 CALIFORNIA ST
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1380
Practice Address - Country:US
Practice Address - Phone:415-386-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist