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Organization
WILLOW GLEN DENTAL SPECIALISTS
Active
Organization
WILLOW GLEN DENTAL SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSIE ADAME (MEDICAL BILLING SPECIALIST)
(408) 266-6144
Entity
Organization
Contact information
Practice address
1706 WILLOW ST STE A, SAN JOSE, CA 95125-5216
(408) 504-4935
Mailing address
1706 WILLOW ST STE A, SAN JOSE, CA 95125-5216
(408) 478-9081
(408) 904-7201
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DDS54347
NULL
122300000X
Dentist
DDS54347
—
1223E0200X
Endodontics
—
NULL
1223E0200X
Endodontics
—
—
1223P0300X
Periodontics
—
NULL
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
NULL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
09/28/2017
Last updated
05/10/2018
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