Healthcare Provider Details

I. General information

NPI: 1982327706
Provider Name (Legal Business Name): LAMASO JOHNY SADA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/08/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E ORANGEBURG AVE STE C
MODESTO CA
95350-5355
US

IV. Provider business mailing address

2505 CANCUN CT
MODESTO CA
95355-7944
US

V. Phone/Fax

Practice location:
  • Phone: 209-322-4331
  • Fax:
Mailing address:
  • Phone: 209-872-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: