Provider Demographics
NPI:1235535519
Name:LIVERMORE DENTAL CARE
Entity type:Organization
Organization Name:LIVERMORE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-455-9510
Mailing Address - Street 1:1171 MURRIETA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4143
Mailing Address - Country:US
Mailing Address - Phone:925-455-9510
Mailing Address - Fax:925-455-9517
Practice Address - Street 1:1171 MURRIETA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4143
Practice Address - Country:US
Practice Address - Phone:925-455-9510
Practice Address - Fax:925-455-9517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4059601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty