| Orthodontics Clinic | |
|
155 5th St Suite 3e San Francisco CA 94103-2919 | |
| (415) 929-6501 | |
| (415) 929-6654 |
| Full Name | Orthodontics Clinic |
|---|---|
| Speciality | Dentist |
| Location | 155 5th St, San Francisco, California |
| Authorized Official Name and Position | Ed Pegueros (ASST DEAN, BUDGET & FIN ADMIN) |
| Authorized Official Contact | 4153517192 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Orthodontics Clinic 155 5th St Suite 3e San Francisco CA 94103-2919 Ph: (415) 929-6501 | Orthodontics Clinic 155 5th St Suite 3e San Francisco CA 94103-2919 Ph: (415) 929-6501 |
| NPI Number | 1316074149 |
|---|---|
| Provider Enumeration Date | 02/28/2007 |
| Last Update Date | 05/17/2022 |
| Medicare PECOS PAC ID | 2163740861 |
|---|---|
| Medicare Enrollment ID | O20221230001587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316074149 | NPI | - | NPPES |
| G01001-03 | Other | CA | DENTI-CAL IDENTIFICATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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