Organization
ACREE-ISENHOWER DENTAL COPORATION
Active
Other names
First Smiles Children's Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COREY ROBERT ACREE DDS (PRESIDENT)
(209) 529-0674
Entity
Organization
Contact information
Practice address
1801 TULLY ROAD, SUITE B, MODESTO, CA 95350
(209) 343-3500
(209) 527-1971
Mailing address
1801 TULLY ROAD, SUITE B, MODESTO, CA 95350
(209) 343-3500
(209) 527-1971
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
48870
CA
1223P0221X
Pediatric Dentistry
Primary
48880
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20789
DENTAL LICENSE
CA
Enumeration date
02/08/2006
Last updated
08/05/2020
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