Individual
BRENDEN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6070 HELLYER AVE STE 100, SAN JOSE, CA 95138-1048
(408) 224-7878
Mailing address
6070 HELLYER AVE STE 100, SAN JOSE, CA 95138-1048
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
110209
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2024
Last updated
07/28/2024
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