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Organization
M A C T HEALTH BOARD, INCORPORATED
Active
Organization
M A C T HEALTH BOARD, INCORPORATED
Active
Parent organization
MACT HEALTH BOARD, INCORPORATED
Other names
MACT Dental, Angels Camp
Organization subpart
Yes
Provider details
NPI number
Legal business name
MACT HEALTH BOARD, INCORPORATED
Authorized official
JOHN SHAWVER ALEXANDER EXECUTIVE DIRECTOR (EXECUTIVE DIRECTOR)
(209) 754-6258
Entity
Organization
Contact information
Practice address
52 S MAIN STREET, SUITE B, ANGELS CAMP, CA 95222
(209) 754-6262
Mailing address
PO BOX 939, ANGELS CAMP, CA 95222-0939
(209) 754-6262
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1366519431
FQHC
CA
Enumeration date
08/28/2019
Last updated
11/17/2022
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