| NPI | 1588038327 |
|---|---|
| Doing Business As | GRACE DENTAL OF MODESTO |
| Entity Type | Organization |
| Authorized Contact | POOYA SOROOSHIAN Office Manager 925-876-4680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2015-11-17 |