NPI 1649406133 · live from the CMS NPI Registry
1692 Tully Dentistry
Dentist in San Jose, CA. National Provider Identifier 1649406133, active.
NPI record
| NPI | 1649406133 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist 122300000X |
| Practice location | 2114 Senior Road, Suite 25, San Jose, CA 95112 |
| Practice phone | 408-279-2114 |
| Mailing address | 1692 Tully Road, #4, San Jose, CA 95122 |
| Enumerated | June 10, 2009 |
| Last updated | June 10, 2009 |
| Authorized official | Phung Nguyen, Dentist |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist primary | 122300000X | 44749 (CA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.