Provider Demographics
NPI:1174222889
Name:OUTREACH DENTAL GROUP
Entity type:Organization
Organization Name:OUTREACH DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATCHAEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-297-0378
Mailing Address - Street 1:2194 VIZCAYA CIR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-5646
Mailing Address - Country:US
Mailing Address - Phone:415-297-0378
Mailing Address - Fax:
Practice Address - Street 1:450 SUTTER ST RM 1925
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4107
Practice Address - Country:US
Practice Address - Phone:415-297-0378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty