| Innovation Dental | |
|
702 Porter Ave Ste F Stockton CA 95207-4297 | |
| (209) 478-9648 | |
| Not Available |
| Full Name | Innovation Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 702 Porter Ave Ste F, Stockton, California |
| Authorized Official Name and Position | Quan Vo Anh Nguyen (CEO/ MANAGING DENTIST) |
| Authorized Official Contact | 2094789648 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovation Dental 702 Porter Ave Ste F Stockton CA 95207-4297 Ph: (209) 478-9648 | Innovation Dental 702 Porter Ave Ste F Stockton CA 95207-4297 Ph: (209) 478-9648 |
| NPI Number | 1992064364 |
|---|---|
| Provider Enumeration Date | 05/04/2012 |
| Last Update Date | 05/04/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992064364 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 46658 (California) | Primary |
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