| Michael C Ditolla Dds Professional Dental Corporation | |
|
630 S Fairmont Ave Ste D Lodi CA 95240-3803 | |
| (714) 420-4053 | |
| Not Available |
| Full Name | Michael C Ditolla Dds Professional Dental Corporation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 630 S Fairmont Ave Ste D, Lodi, California |
| Authorized Official Name and Position | Michael C Ditolla (PRESIDENT) |
| Authorized Official Contact | 7144204053 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael C Ditolla Dds Professional Dental Corporation 630 S Fairmont Ave Ste D Lodi CA 95240-3803 Ph: (209) 333-3388 | Michael C Ditolla Dds Professional Dental Corporation 630 S Fairmont Ave Ste D Lodi CA 95240-3803 Ph: (714) 420-4053 |
| NPI Number | 1619543568 |
|---|---|
| Provider Enumeration Date | 06/01/2021 |
| Last Update Date | 04/02/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619543568 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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