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1110 W Kettleman Ln Ste 47 Lodi CA 95240-6031 | |
| (209) 224-8104 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1110 W Kettleman Ln, Lodi, California |
| Authorized Official Name and Position | Joseph Bui (CEO/MANAGING DENTIST) |
| Authorized Official Contact | 2095186315 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1110 W Kettleman Ln Suite 47 Lodi CA 95240-6031 Ph: () - | 1110 W Kettleman Ln Ste 47 Lodi CA 95240-6031 Ph: (209) 224-8104 |
| NPI Number | 1255715157 |
|---|---|
| Provider Enumeration Date | 07/10/2015 |
| Last Update Date | 07/21/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255715157 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 54638 (California) | Primary |
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