Full Name | |
---|---|
Speciality | Dentist |
Location | 136 N C St, Exeter, California |
Authorized Official Name and Position | Ali Agahi (OWNER) |
Authorized Official Contact | 5595929017 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
136 N C St Exeter CA 93221-1805 Ph: (559) 592-9017 | 136 N C St Exeter CA 93221-1805 Ph: (559) 592-9017 |
NPI Number | 1376719435 |
---|---|
Provider Enumeration Date | 05/07/2008 |
Last Update Date | 05/07/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376719435 | NPI | - | NPPES |
B35587-01 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 35587 (California) | Primary |