| San Jose Dental Surgery Center, Inc. | |
|
2048 Story Rd San Jose CA 95122-1668 | |
| (408) 240-9000 | |
| Not Available |
| Full Name | San Jose Dental Surgery Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2048 Story Rd, San Jose, California |
| Authorized Official Name and Position | Kham Nguyen (VICE PRESIDENT) |
| Authorized Official Contact | 4082409000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Jose Dental Surgery Center, Inc. 2048 Story Rd San Jose CA 95122-1668 Ph: (408) 240-9000 | San Jose Dental Surgery Center, Inc. 2048 Story Rd San Jose CA 95122-1668 Ph: (408) 240-9000 |
| NPI Number | 1902086606 |
|---|---|
| Provider Enumeration Date | 11/09/2007 |
| Last Update Date | 04/05/2025 |
| Medicare PECOS PAC ID | 0941325666 |
|---|---|
| Medicare Enrollment ID | O20100917000195 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902086606 | NPI | - | NPPES |
| D52747 | Other | CA | DENTI-CAL LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D52747 (California) | Secondary |
| 261QA1903X | Clinic/center - Ambulatory Surgical | D52747 (California) | Primary |
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