| Coffee Dental Group | |
|
1130 Coffee Rd Ste 1a Modesto CA 95355-4228 | |
| (209) 523-5991 | |
| Not Available |
| Full Name | Coffee Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 1130 Coffee Rd Ste 1a, Modesto, California |
| Authorized Official Name and Position | David Park (OWNER) |
| Authorized Official Contact | 3104031117 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coffee Dental Group 1130 Coffee Rd Ste 1a Modesto CA 95355-4228 Ph: () - | Coffee Dental Group 1130 Coffee Rd Ste 1a Modesto CA 95355-4228 Ph: (209) 523-5991 |
| NPI Number | 1174869796 |
|---|---|
| Provider Enumeration Date | 12/31/2012 |
| Last Update Date | 12/31/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174869796 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 53724 (California) | Primary |
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