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1601 Mchenry Village Way Ste 10-a Modesto CA 95350-4307 | |
| (209) 527-5727 | |
| (209) 527-4626 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1601 Mchenry Village Way, Modesto, California |
| Authorized Official Name and Position | Mary Lou Fitzpatrick (OWNER) |
| Authorized Official Contact | 2095274631 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1601 Mchenry Village Way Ste 10-a Modesto CA 95350-4307 Ph: (209) 527-5727 | 1601 Mchenry Village Way Ste 10-a Modesto CA 95350-4307 Ph: (209) 527-5727 |
| NPI Number | 1386813509 |
|---|---|
| Provider Enumeration Date | 02/21/2008 |
| Last Update Date | 02/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386813509 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 39633 (California) | Primary |
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