Organization
CENTER FOR IMPLANT DENTISTRY PRESTIGE DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANUEL FUENTES (BILLING MANGER)
(310) 870-9652
Entity
Organization
Contact information
Practice address
3381 WALNUT AVE, FREMONT, CA 94538-2217
(510) 574-0496
(510) 574-0499
Mailing address
3381 WALNUT AVE, FREMONT, CA 94538-2217
(510) 574-0496
(510) 574-0499
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
07/30/2020
Last updated
07/30/2020
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