Organization
COUNTY OF SANTA CLARA
Active
Other names
Ronald McDonald Dental Mobile Unit
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALFONSO F BANUELOS JR. MD (CHIEF MEDICAL OFFICER)
40888854001
Entity
Organization
Contact information
Practice address
500 TULLY RD, RONALD MCDONALD DENTAL MOBILE UNIT, SAN JOSE, CA 95111-1917
(408) 885-5000
Mailing address
PO BOX 5280, PATIENT BUSINESS SERVICES, SAN JOSE, CA 95150-5280
(408) 885-5000
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC80060F
—
CA
Enumeration date
11/06/2006
Last updated
09/11/2025
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