Provider Demographics
NPI:1982955720
Name:GOLDEN GATE DENTAL GROUP PRACTICE OF INESSA SOSIS DDS INC
Entity Type:Organization
Organization Name:GOLDEN GATE DENTAL GROUP PRACTICE OF INESSA SOSIS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:INESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-516-3859
Mailing Address - Street 1:3200 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3713
Mailing Address - Country:US
Mailing Address - Phone:415-516-3859
Mailing Address - Fax:
Practice Address - Street 1:3200 FULTON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3713
Practice Address - Country:US
Practice Address - Phone:415-516-3859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty