Provider Demographics
NPI:1932572435
Name:VLADISLAV KAMANIN D.D.S., INC.
Entity Type:Organization
Organization Name:VLADISLAV KAMANIN D.D.S., INC.
Other - Org Name:VAN NESS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VLADISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMANIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-487-1500
Mailing Address - Street 1:1336 VAN NESS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5544
Mailing Address - Country:US
Mailing Address - Phone:415-487-1500
Mailing Address - Fax:415-487-1055
Practice Address - Street 1:1336 VAN NESS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5544
Practice Address - Country:US
Practice Address - Phone:415-487-1500
Practice Address - Fax:415-487-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty