Individual
DR. MICHAEL SIMONTACCHI-GBOLOGAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1305 UNION ST., ALAMEDA, CA 94501
(202) 213-6080
Mailing address
1305 UNION ST., ALAMEDA, CA 94501
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
59845
CA
Other
Enumeration date
12/01/2010
Last updated
12/01/2010
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