UCSF Periodontal Specialty Clinic

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

2087 Issued in CA

Legal business name

UCSF PERIODONTAL SPECIALTY CLINIC

Practice address

707 Parnassus Ave
D-3013
San Francisco, CA 94143-2210

Phone

(415) 476-1634

Fax

(415) 476-1563

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Charles Bertolami, DDS

Title

Dean

Phone

(415) 476-1323

Specialties & licenses 1

Addresses

Tax ID family

UCSF Periodontal Specialty Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• UCSF Periodontal Specialty Clinic

  • Periodontics
  • San Francisco, CA
  • NPI 1497829162
  NPD tax ID

Locations

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710065255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 PARNASSUS AVE",
            "address_2": "D-3013",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941432210",
            "telephone_number": "415-476-1634",
            "fax_number": "415-476-1563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 PARNASSUS AVE",
            "address_2": "D-3013",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941432210",
            "telephone_number": "415-476-1634",
            "fax_number": "415-476-1563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UCSF PERIODONTAL SPECIALTY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BERTOLAMI",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "DEAN",
        "authorized_official_telephone_number": "415-476-1323",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "2087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• UCSF Pediatric Associates
• UCSF Pediatric Dentistry
• UCSF Pediatric Dentistry
• UCSF Pediatrics Associates
• UCSF Periodontal Specialty Clinic
• UCSF Psychiatry
• UCSF School of Dentistry
• UCSF School of Dentistry Clinic No. 1
• UCSF School of Dentistry Clinic No. 1
• UCSF School of Medicine

• Periodontics in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Periodontics in California

• 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.