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Peninsula Pediatric Dental Practice
Pediatric Dentist in San Mateo, California
NPI 1639590003

Peninsula Pediatric Dental Practice is a Pediatric Dentist based in San Mateo, CA and is specialized in Pediatric Dentistry. Peninsula Pediatric Dental Practice practices in San Mateo, CA. The NPI Number for Peninsula Pediatric Dental Practice is 1639590003 and holds a License No. 22673 (California).

The current practice location address for Peninsula Pediatric Dental Practice is 50 S San Mateo Dr Ste 160, San Mateo, CA and can be reached out via phone at 650-375-8300 and via fax at 650-375-8130.

Location: 50 S San Mateo Dr Ste 160, San Mateo, CA, 94401-3859
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1639590003
Provider Name
Peninsula Pediatric Dental Practice
Credential
Provider Entity Type
Organization
Address
50 S San Mateo Dr Ste 160, San Mateo, CA, 94401-3859
Phone Number
650-375-8300
Fax Number
650-375-8130
Provider Enumeration Date
01/02/2014
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1386792919 01 CA DENTICAL
1386792919 01 CA ALL INSURANCE CARRIER
institution
Provider Business Practice Location Address Details
Address
50 S San Mateo Dr Ste 160
City
San Mateo
State
California
Zip
94401-3859
Phone Number
650-375-8300
Fax Number
650-375-8130
person
Provider Business Mailing Address Details
Address
50 S San Mateo Dr Ste 160
City
San Mateo
State
California
Zip
94401-3859
Phone Number
650-375-8300
Fax Number
650-375-8130
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
22673 (California)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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