| Moreno Dental Group, Pdc | |
|
3427 Deer Park Dr Suite #c Stockton CA 95219-2355 | |
| (209) 478-3036 | |
| (209) 478-0258 |
| Full Name | Moreno Dental Group, Pdc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 3427 Deer Park Dr, Stockton, California |
| Authorized Official Name and Position | Janice Gale Moreno (PRESIDENT, TREAS.) |
| Authorized Official Contact | 2094783036 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moreno Dental Group, Pdc 3427 Deer Park Dr Suite #c Stockton CA 95219-2355 Ph: (209) 478-3036 | Moreno Dental Group, Pdc 3427 Deer Park Dr Suite #c Stockton CA 95219-2355 Ph: (209) 478-3036 |
| NPI Number | 1790866309 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790866309 | NPI | - | NPPES |
| 1860612 | Other | CA | STATE CORPORATION NUMBER |
| 33195579 | Other | CA | STATE OF CAL. EDD NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 34387 (California) | Primary |
| 122300000X | Dentist | 54645 (California) | Primary |
| 1223P0300X | Dentist - Periodontics | 32491 (California) | Primary |
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