Organization
COMMUNITY DENTAL SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARCUS S. KASPRZYK (ADMINISTRATOR)
(209) 602-0212
Entity
Organization
Contact information
Practice address
1523 E MARCH LN, SUITE 100, STOCKTON, CA 95310-5600
(209) 602-0212
Mailing address
1523 E MARCH LN, SUITE 100, STOCKTON, CA 95210-5600
(209) 602-0201
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
G58822
CA
Other
Enumeration date
04/29/2008
Last updated
04/29/2008
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