| Pacific Dental Group | |
|
7743 West Ln Ste C5 Stockton CA 95210-3381 | |
| (209) 474-1101 | |
| Not Available |
| Full Name | Pacific Dental Group |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 7743 West Ln Ste C5, Stockton, California |
| Authorized Official Name and Position | David Sangho Park (CEO, CFO) |
| Authorized Official Contact | 3104031117 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Dental Group 7743 West Ln Ste C5 Stockton CA 95210-3381 Ph: (209) 474-1101 | Pacific Dental Group 7743 West Ln Ste C5 Stockton CA 95210-3381 Ph: (209) 474-1101 |
| NPI Number | 1124572284 |
|---|---|
| Provider Enumeration Date | 08/06/2016 |
| Last Update Date | 01/11/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124572284 | NPI | - | NPPES |
| 53724 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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