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569 W Lowell Ave Ste 200 Tracy CA 95376-3084 | |
| (209) 832-5800 | |
| (209) 832-5800 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 569 W Lowell Ave Ste 200, Tracy, California |
| Authorized Official Name and Position | Maria C Borrero (PRESIDENT) |
| Authorized Official Contact | 2098325800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
569 W Lowell Ave Ste 200 Tracy CA 95376-3084 Ph: (209) 832-5800 | 569 W Lowell Ave Ste 200 Tracy CA 95376-3084 Ph: (209) 832-5800 |
| NPI Number | 1437801529 |
|---|---|
| Provider Enumeration Date | 01/20/2022 |
| Last Update Date | 02/08/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437801529 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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