Provider Demographics
NPI:1215900840
Name:UNIVERSITY OF THE PACIFIC
Entity type:Organization
Organization Name:UNIVERSITY OF THE PACIFIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DEAN OF FISCAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGUEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-351-7192
Mailing Address - Street 1:155 5TH ST
Mailing Address - Street 2:UNIVERSITY OF THE PACIFIC ARTHUR DUGONI SCHOOL OF DENTI
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2919
Mailing Address - Country:US
Mailing Address - Phone:415-929-6400
Mailing Address - Fax:415-929-6654
Practice Address - Street 1:155 5TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2919
Practice Address - Country:US
Practice Address - Phone:415-749-3324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF THE PACIFIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-13
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG0-1001-01OtherDENTI-CAL
CAG0-1001-04OtherDENTI-CAL
CAG0-1001-05OtherDENTI-CAL
CAG0-1001-02OtherDENTI-CAL
CAG0-1001-03OtherDENTI-CAL