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Organization
TIN DENTAL SPECIALTY GROUP A PROFESSIONAL DENTAL CORP
Active
Organization
TIN DENTAL SPECIALTY GROUP A PROFESSIONAL DENTAL CORP
Active
Other names
SL Dental Specialty Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN TIN DDS (CEO)
(415) 218-3866
Entity
Organization
Contact information
Practice address
1436 CLARKE ST, SAN LEANDRO, CA 94577-3635
(415) 987-0260
Mailing address
1436 CLARKE ST, SAN LEANDRO, CA 94577-3635
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37744
DENTICAL
CA
Enumeration date
05/19/2017
Last updated
05/19/2017
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