Organization
M ELDER DENTAL GROUP CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMY MONTES (DIRECTOR OF CENTRALIZED BILLING)
(415) 246-6305
Entity
Organization
Contact information
Practice address
704 BLOSSOM HILL RD STE 102, SAN JOSE, CA 95123-5403
(408) 225-5000
Mailing address
446 MERLOT LN, AMERICAN CANYON, CA 94503-1243
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
06/28/2019
Last updated
06/28/2019
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