| Ronald Mcdonald Dental Mobile Unit | |
|
500 Tully Rd Ronald Mcdonald Dental Mobile Unit San Jose CA 95111-1917 | |
| (408) 885-5000 | |
| Not Available |
| Full Name | Ronald Mcdonald Dental Mobile Unit |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 500 Tully Rd, San Jose, California |
| Authorized Official Name and Position | Alfonso F Banuelos (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 40888854001 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ronald Mcdonald Dental Mobile Unit Po Box 5280 Patient Business Services San Jose CA 95150-5280 Ph: (408) 885-5000 | Ronald Mcdonald Dental Mobile Unit 500 Tully Rd Ronald Mcdonald Dental Mobile Unit San Jose CA 95111-1917 Ph: (408) 885-5000 |
| NPI Number | 1205915501 |
|---|---|
| Provider Enumeration Date | 11/06/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205915501 | NPI | - | NPPES |
| FHC80060F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (California) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (California) | Primary |
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