Organization
CHILDREN'S DENTAL INITIATIVE
Active
Other names
THE HEALTH TRUST
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IRA HOLTZMAN (CHIEF FINANCIAL OFFICER)
(408) 961-9869
Entity
Organization
Contact information
Practice address
645 WOOL CREEK DR, SAN JOSE, CA 95112-2617
(408) 961-9869
Mailing address
2085 HAMILTON AVE, STE. 150, SAN JOSE, CA 95125-6117
(408) 961-9869
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
G91493-01
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G91493-01
—
CA
Enumeration date
04/17/2007
Last updated
08/22/2020
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