| Prosmile Family Dentist | |
|
3430 Tully Rd Ste 21 Modesto CA 95350-0840 | |
| (215) 436-7600 | |
| Not Available |
| Full Name | Prosmile Family Dentist |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3430 Tully Rd Ste 21, Modesto, California |
| Authorized Official Name and Position | Ajaykumar Patel (PRESIDENT) |
| Authorized Official Contact | 2154367600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prosmile Family Dentist 2800 Braden Ave Apt 163 Modesto CA 95356-0678 Ph: () - | Prosmile Family Dentist 3430 Tully Rd Ste 21 Modesto CA 95350-0840 Ph: (215) 436-7600 |
| NPI Number | 1588191126 |
|---|---|
| Provider Enumeration Date | 05/14/2017 |
| Last Update Date | 05/14/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588191126 | NPI | - | NPPES |
| 1548608425 | Other | PA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 100043 (California) | Primary |
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