Organization
UCSF DIVISION OF ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES N BERTOLAMI (DEAN SCHOOL OF DENTISTRY)
(415) 476-1323
Entity
Organization
Contact information
Practice address
707 PARNASSUS AVE BOX 0438, SAN FRANCISCO, CA 94143-0438
(415) 502-6707
(415) 514-0377
Mailing address
707 PARNASSUS AVE BOX 0438, SAN FRANCISCO, CA 94143-0438
(415) 502-6707
(415) 514-0377
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003
DELTA DENTAL PROVIDER #
CA
01
—
CGP166827
CALIFORNIA CHILDRENS SERV
CA
01
—
G02003-01
DENTI-CAL PROVIDER #
CA
Enumeration date
11/22/2006
Last updated
08/22/2020
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