| Dental Source Of California | |
|
1015 5th St Modesto CA 95351-2810 | |
| (209) 577-4263 | |
| (209) 577-2056 |
| Full Name | Dental Source Of California |
|---|---|
| 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 |
|---|---|
| Dental Source Of California 1015 5th St Modesto CA 95351-2810 Ph: (209) 577-4263 | Dental Source Of California 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 |
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