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3609 Coffee Rd Ste 3 Modesto CA 95355-1100 | |
| (209) 526-1190 | |
| (209) 526-3245 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3609 Coffee Rd Ste 3, Modesto, California |
| Authorized Official Name and Position | Elizabeth Manzo Sotomil (OWNER) |
| Authorized Official Contact | 2095261190 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3609 Coffee Rd Ste 3 Modesto CA 95355-1100 Ph: (209) 526-1190 | 3609 Coffee Rd Ste 3 Modesto CA 95355-1100 Ph: (209) 526-1190 |
| NPI Number | 1184185753 |
|---|---|
| Provider Enumeration Date | 03/27/2019 |
| Last Update Date | 08/21/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184185753 | NPI | - | NPPES |
| 1154629566 | Medicaid | CA |
| 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 | |