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1736 E 14th St San Leandro CA 94577-4803 | |
| (510) 351-1400 | |
| (510) 351-3116 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1736 E 14th St, San Leandro, California |
| Authorized Official Name and Position | Walter F. Tickner (OWNER/DENTIST) |
| Authorized Official Contact | 5103511400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1736 E 14th St San Leandro CA 94577-4803 Ph: (510) 351-1400 | 1736 E 14th St San Leandro CA 94577-4803 Ph: (510) 351-1400 |
| NPI Number | 1073627345 |
|---|---|
| Provider Enumeration Date | 08/17/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073627345 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 23418 (California) | Primary |
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