Dr. Erline Diona Poerwanto, D.D.S
Dentist, General Practice in San Francisco, CA. Individual provider (NPI-1).
NPI number1194152736
StatusActive
Last updated in NPPESSep 27, 2013
Details
- NPI
- 1194152736
- Entity type
- Individual (NPI-1)
- Name
- Dr. Erline Diona Poerwanto
- Credential
- D.D.S
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 27, 2013
- Last updated
- Sep 27, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 62687 | CA | Yes |
| 122300000X | Dentist | 62687 | CA |
Practice location
2155 Webster StreetSan Francisco, CA 94115
Phone 209-910-3505
Mailing address
Po Box 7194Stockton, CA 95267-0194
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