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1341 N El Dorado St Stockton CA 95202-1016 | |
| (209) 465-5747 | |
| (206) 465-3602 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1341 N El Dorado St, Stockton, California |
| Authorized Official Name and Position | Everett Leman Low (SECRETARY/TREASURER) |
| Authorized Official Contact | 2094655747 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1341 N El Dorado St Stockton CA 95202-1016 Ph: (209) 465-5747 | 1341 N El Dorado St Stockton CA 95202-1016 Ph: (209) 465-5747 |
| NPI Number | 1184818569 |
|---|---|
| Provider Enumeration Date | 08/29/2007 |
| Last Update Date | 10/10/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184818569 | NPI | - | NPPES |
| 26885-01 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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