| Vista Modern Dentistry Dental Group | |
|
1350 E Vista Way Ste 10 Vista CA 92084-4037 | |
| (760) 208-1173 | |
| (760) 206-7231 |
| Full Name | Vista Modern Dentistry Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 1350 E Vista Way Ste 10, Vista, California |
| Authorized Official Name and Position | Ronny Le (GENERAL DENTIST/OWNER) |
| Authorized Official Contact | 7602081173 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vista Modern Dentistry Dental Group Po Box 920050 Dallas TX 75392-0050 Ph: (714) 845-8500 | Vista Modern Dentistry Dental Group 1350 E Vista Way Ste 10 Vista CA 92084-4037 Ph: (760) 208-1173 |
| NPI Number | 1871147983 |
|---|---|
| Provider Enumeration Date | 07/26/2019 |
| Last Update Date | 03/08/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871147983 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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