Organization
GILL DALLA DENTAL INC
Active
Other names
Modern Dental and Implants
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEVAN DALLA DDS (CEO)
(646) 427-6519
Entity
Organization
Contact information
Practice address
601 W KETTLEMAN LN, LODI, CA 95240-6006
(209) 366-1850
Mailing address
601 W KETTLEMAN LN, LODI, CA 95240-6006
(209) 366-1850
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/25/2020
Last updated
07/01/2020
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