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Organization
JEFFREY PHEN DDS A DENTAL CORPORATION
Active
Organization
JEFFREY PHEN DDS A DENTAL CORPORATION
Active
Other names
Venetian Square Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY PHEN DDS (DENTIST)
(209) 474-0888
Entity
Organization
Contact information
Practice address
850 W MARCH LN, SUITE B, STOCKTON, CA 95207-6207
(209) 474-0888
(209) 474-3342
Mailing address
850 W MARCH LN, SUITE B, STOCKTON, CA 95207-6207
(209) 474-0888
(209) 474-3342
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
44988
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G91849
DELTA DENTAL HEATHY FAMIL
CA
05
—
G91849
—
CA
Enumeration date
01/10/2008
Last updated
07/08/2010
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