Individual
AMI GAMI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1008 6TH ST, MODESTO, CA 95354-2209
(209) 722-4842
Mailing address
547 WELLMAN CT, MERCED, CA 95348-8514
(848) 213-2668
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
109631
CA
Other
Enumeration date
10/31/2023
Last updated
02/14/2025
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