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4120 Prescott Rd Ste B Modesto CA 95356-8418 | |
| (650) 296-8417 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4120 Prescott Rd Ste B, Modesto, California |
| Authorized Official Name and Position | Baljot Bains (CEO) |
| Authorized Official Contact | 2097184300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3304 Ridgemont Ct Modesto CA 95355-8449 Ph: () - | 4120 Prescott Rd Ste B Modesto CA 95356-8418 Ph: (650) 296-8417 |
| NPI Number | 1649869587 |
|---|---|
| Provider Enumeration Date | 01/14/2021 |
| Last Update Date | 03/23/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649869587 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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