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1130 Coffee Rd Ste 1a Modesto CA 95355-4228 | |
(209) 523-5991 | |
Not Available |
Full Name | |
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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 |
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1130 Coffee Rd Ste 1a Modesto CA 95355-4228 Ph: () - | 1130 Coffee Rd Ste 1a Modesto CA 95355-4228 Ph: (209) 523-5991 |
NPI Number | 1174869796 |
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Provider Enumeration Date | 12/31/2012 |
Last Update Date | 12/31/2012 |
Identifier | Type | State | Issuer |
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1174869796 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | 53724 (California) | Primary |
Roger B. Wei, Dds, A Professional Corporation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2225 Plaza Pkwy Ste C12, Modesto, CA 95350 Phone: 209-491-3620 | |
A S Gill Dental Corp Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1518 Coffee Rd Ste B, Modesto, CA 95355 Phone: 209-809-0123 | |
Stephanie Diego Dental Corporation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1130 Coffee Rd Ste 8a, Modesto, CA 95355 Phone: 209-566-1990 | |