West Dental Corporation
Clinic/Center, Dental in Modesto, CA. Organization (NPI-2).
NPI number1124697990
StatusActive
Last updated in NPPESJun 24, 2021
Details
- NPI
- 1124697990
- Entity type
- Organization (NPI-2)
- Legal business name
- West Dental Corporation
- Organization subpart
- No
- Enumeration date
- Jun 24, 2021
- Certification date
- Jun 24, 2021
- Last updated
- Jun 24, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
1236 Floyd Ave Ste CModesto, CA 95350-2472
Phone 209-524-5515
Mailing address
1500 McHenry AveModesto, CA 95350-4529
Phone 209-526-0462 · Fax 209-526-9223
Other practice locations
1500 McHenry Ave
Modesto, CA 95350-4529
Modesto, CA 95350-4529
Phone 209-526-0462 · Fax 209-526-9223
Authorized official
Jeremy Thomas West
President
2095260462
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