Organization
GREATER MODESTO DENTAL IMPLANT &ORAL SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA BRUNO (ADMINISTRATOR)
(209) 527-5050
Entity
Organization
Contact information
Practice address
201 E ORANGEBURG AVE, SUITE A, MODESTO, CA 95350-5355
(209) 527-5050
(209) 527-0659
Mailing address
201 E ORANGEBURG AVE, SUITE A, MODESTO, CA 95350-5355
(209) 527-5050
(209) 527-0659
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
32447
CA
Other
Enumeration date
04/24/2014
Last updated
07/01/2016
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