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2201 Balfour Rd Ste E Brentwood CA 94513-4927 | |
| (925) 308-7908 | |
| (925) 308-7910 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2201 Balfour Rd Ste E, Brentwood, California |
| Authorized Official Name and Position | Jesse Michael Fa (OWNER) |
| Authorized Official Contact | 9257572217 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2201 Balfour Rd Ste E Brentwood CA 94513-4927 Ph: (925) 308-7908 | 2201 Balfour Rd Ste E Brentwood CA 94513-4927 Ph: (925) 308-7908 |
| NPI Number | 1649689597 |
|---|---|
| Provider Enumeration Date | 08/05/2014 |
| Last Update Date | 04/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649689597 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 55360 (California) | Primary |
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