# WILLOW GLEN DENTAL SPECIALISTS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609385020
- **Authorized official:** ROSIE ADAME (MEDICAL BILLING SPECIALIST)
- **Authorized official phone:** (408) 266-6144

## Contact information

- **Practice address:** 1706 WILLOW ST STE A, SAN JOSE, CA 95125-5216
- **Practice address phone:** (408) 504-4935
- **Mailing address:** 1706 WILLOW ST STE A, SAN JOSE, CA 95125-5216
- **Mailing address phone:** (408) 478-9081
- **Mailing address fax:** (408) 904-7201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DDS54347 | NULL | — |
| 122300000X | Dentist | DDS54347 | — | — |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |

## Other

- **Enumeration date:** 09/28/2017
- **Last updated:** 05/10/2018