NPIMap

Organization Active NPI

San Bruno Ave Dental Clinic Corp

  • General Practice Dentistry
  • San Francisco, CA
National Provider Identifier
1639228950
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
B37744 Issued in CA
Legal business name
SAN BRUNO AVE DENTAL CLINIC CORP
Practice address
2817 San Bruno Ave
San Francisco, CA 94134-1510
Phone
(415) 656-2868
Fax
(415) 656-2865
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Justin Tin, DDSNPI 1124233663
Title
Senior Dentist
Phone
(415) 656-2868

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X B37744 CA Primary

Addresses

Primary practice location

2817 San Bruno Ave
San Francisco, CA 94134-1510

Mailing address

2817 San Bruno Ave
San Francisco, CA 94134-1510
Phone (415) 656-2868

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639228950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 SAN BRUNO AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941341510",
            "telephone_number": "415-656-2868",
            "fax_number": "415-656-2865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 SAN BRUNO AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941341510",
            "telephone_number": "415-656-2868",
            "fax_number": "415-656-2865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN BRUNO AVE DENTAL CLINIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TIN",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "SENIOR DENTIST",
        "authorized_official_telephone_number": "415-656-2868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "B37744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.