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3848 Mchenry Ave Ste 130 Modesto CA 95356-1599 | |
| (209) 523-2100 | |
| (209) 523-2101 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3848 Mchenry Ave Ste 130, Modesto, California |
| Authorized Official Name and Position | Jotsna Gangadharan (OWNER/DDS) |
| Authorized Official Contact | 2095232100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3848 Mchenry Ave Ste 130 Modesto CA 95356-1599 Ph: (209) 523-2100 | 3848 Mchenry Ave Ste 130 Modesto CA 95356-1599 Ph: (209) 523-2100 |
| NPI Number | 1407367824 |
|---|---|
| Provider Enumeration Date | 10/12/2017 |
| Last Update Date | 10/12/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407367824 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 53790 (California) | Primary |
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