Organization
PURE SMILE DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOUTAZ KOTROB DDS (OWNER)
(650) 244-9928
Entity
Organization
Contact information
Practice address
1133 EL CAMINO REAL STE 5, SOUTH SAN FRANCISCO, CA 94080-3288
(650) 244-9928
(650) 244-9284
Mailing address
1133 EL CAMINO REAL STE 5, SOUTH SAN FRANCISCO, CA 94080-3288
(650) 244-9928
(650) 244-9284
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
55981
CA
Other
Enumeration date
03/15/2012
Last updated
03/15/2012
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