Healthcare Provider Details

I. General information

NPI: 1356096523
Provider Name (Legal Business Name): TOSHI HART DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4213 DALE RD # B6
MODESTO CA
95356-8505
US

IV. Provider business mailing address

4213 DALE RD # B6
MODESTO CA
95356-8505
US

V. Phone/Fax

Practice location:
  • Phone: 209-543-6937
  • Fax: 209-297-4406
Mailing address:
  • Phone: 209-543-6937
  • Fax: 209-297-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TOSHIKO HART
Title or Position: OWNER
Credential: DDS
Phone: 209-543-6937