Healthcare Provider Details

I. General information

NPI: 1043473408
Provider Name (Legal Business Name): DAVID DINH DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 S CHEROKEE LN SUIT #G
LODI CA
95240-4341
US

IV. Provider business mailing address

920 S CHEROKEE LN SUIT #G
LODI CA
95240-4341
US

V. Phone/Fax

Practice location:
  • Phone: 209-333-6091
  • Fax: 209-333-6093
Mailing address:
  • Phone: 209-333-6091
  • Fax: 209-333-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number47068
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID QUANG DINH
Title or Position: PRESIDENT
Credential: DDS
Phone: 209-333-6091