| NPI | 1821461104 |
|---|---|
| Doing Business As | MODESTO MODERN DENTISTRY DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | MICAHEL LOPEZ Owner Doctor 209-435-9550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2015-11-09 |