| Ravenswood Family Dentistry | |
|
1807 Bay Road East Palo Alto CA 94303-1312 | |
| (650) 330-7407 | |
| (650) 321-1560 |
| Full Name | Ravenswood Family Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1807 Bay Road, East Palo Alto, California |
| Authorized Official Name and Position | Luisa M. Buada (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6503307410 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ravenswood Family Dentistry 1885 Bay Rd East Palo Alto CA 94303-1312 Ph: (650) 330-7410 | Ravenswood Family Dentistry 1807 Bay Road East Palo Alto CA 94303-1312 Ph: (650) 330-7407 |
| NPI Number | 1184957771 |
|---|---|
| Provider Enumeration Date | 09/14/2009 |
| Last Update Date | 08/31/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184957771 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | APPLIED FOR (California) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | APPLIED FOR (California) | Secondary |
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