Organization
BIRCH DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARK L FONG, DDS DDS (OWNER)
(650) 366-0552
Entity
Organization
Contact information
Practice address
155 BIRCH ST, SUITE 5, REDWOOD CITY, CA 94062-1340
(650) 366-0552
(650) 366-0701
Mailing address
155 BIRCH ST, SUITE 5, REDWOOD CITY, CA 94062-1340
(650) 366-0552
(650) 366-0701
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
40351
CA
Other
Enumeration date
09/14/2007
Last updated
03/18/2010
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