# M ELDER DENTAL GROUP CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215599394
- **Authorized official:** EMMY MONTES (DIRECTOR OF CENTRALIZED BILLING)
- **Authorized official phone:** (415) 246-6305

## Contact information

- **Practice address:** 704 BLOSSOM HILL RD STE 102, SAN JOSE, CA 95123-5403
- **Practice address phone:** (408) 225-5000
- **Mailing address:** 446 MERLOT LN, AMERICAN CANYON, CA 94503-1243

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 06/28/2019
- **Last updated:** 06/28/2019