| Pure Smile Dental Group | |
|
1133 El Camino Real Ste 5 South San Francisco CA 94080-3288 | |
| (650) 244-9928 | |
| (650) 244-9284 |
| Full Name | Pure Smile Dental Group |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1133 El Camino Real Ste 5, South San Francisco, California |
| Authorized Official Name and Position | Moutaz Kotrob (OWNER) |
| Authorized Official Contact | 6502449928 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pure Smile Dental Group 1133 El Camino Real Ste 5 South San Francisco CA 94080-3288 Ph: (650) 244-9928 | Pure Smile Dental Group 1133 El Camino Real Ste 5 South San Francisco CA 94080-3288 Ph: (650) 244-9928 |
| NPI Number | 1609141274 |
|---|---|
| Provider Enumeration Date | 03/15/2012 |
| Last Update Date | 03/15/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609141274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 55981 (California) | Primary |
Raymond J. Sheridan D.d.s. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2400 Westborough Blvd, Suite 107, South San Francisco, CA 94080 Phone: 650-876-0866 | |
Kelvin C. Choi, D.d.s., Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2400 Westborough Blvd, Suite 103, South San Francisco, CA 94080 Phone: 650-871-1400 Fax: 650-871-5541 | |
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