Provider Demographics
NPI:1922510189
Name:ANTIPOV DENTAL INC
Entity type:Organization
Organization Name:ANTIPOV DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTIPOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-800-7594
Mailing Address - Street 1:490 POST ST STE 1022
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1301
Mailing Address - Country:US
Mailing Address - Phone:415-800-7594
Mailing Address - Fax:415-800-7969
Practice Address - Street 1:490 POST ST STE 1022
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1301
Practice Address - Country:US
Practice Address - Phone:415-800-7594
Practice Address - Fax:415-800-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61522261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental