| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1015 5th St, Modesto, California |
| Authorized Official Name and Position | Donald Clarke (CORPORATION PRESIDENT) |
| Authorized Official Contact | 9164870117 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1015 5th St Modesto CA 95351-2810 Ph: (209) 577-4263 | 1015 5th St Modesto CA 95351-2810 Ph: (209) 577-4263 |
| NPI Number | 1104156744 |
|---|---|
| Provider Enumeration Date | 01/04/2010 |
| Last Update Date | 01/04/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104156744 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | 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 | |