Organization
BLOSSOM HILL DENTAL CLINIC
Active
Parent organization
RICHMOND DENTAL CARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
RICHMOND DENTAL CARE
Authorized official
MR. YURI UNDORF DDS (OWNER)
(415) 752-5605
Entity
Organization
Contact information
Practice address
5460 DELLWOOD WAY STE A, SAN JOSE, CA 95118-2965
(408) 266-1117
Mailing address
5460 DELLWOOD WAY STE A, SAN JOSE, CA 95118-2965
(408) 266-1117
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
40751
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G9111501
DENTI CAL NUMBER ISSUED FOR OFFICE #1
CA
Enumeration date
04/30/2008
Last updated
04/30/2008
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