1326468752 NPI number — GREATER MODESTO DENTAL IMPLANT &ORAL SURGERY CENTER

Table of content: (NPI 1326468752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326468752 NPI number — GREATER MODESTO DENTAL IMPLANT &ORAL SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER MODESTO DENTAL IMPLANT &ORAL SURGERY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326468752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 E ORANGEBURG AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95350-5355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-527-5050
Provider Business Mailing Address Fax Number:
209-527-0659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E ORANGEBURG AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95350-5355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-527-5050
Provider Business Practice Location Address Fax Number:
209-527-0659
Provider Enumeration Date:
04/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNO
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
209-527-5050

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  32447 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com