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883 Sneath Lane #130 San Bruno CA 94066 | |
| (650) 589-4563 | |
| (605) 589-1155 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 883 Sneath Lane, San Bruno, California |
| Authorized Official Name and Position | David T Shen (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6505894563 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
883 Sneath Lane #130 San Bruno CA 94066 Ph: (650) 589-4563 | 883 Sneath Lane #130 San Bruno CA 94066 Ph: (650) 589-4563 |
| NPI Number | 1285788794 |
|---|---|
| Provider Enumeration Date | 01/22/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285788794 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (California) | Primary |
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