Healthcare Provider Details

I. General information

NPI: 1609041813
Provider Name (Legal Business Name): DENTAL SURGERY CENTERS OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 E MARCH LN STE A
STOCKTON CA
95210-5607
US

IV. Provider business mailing address

1523 E MARCH LN STE A
STOCKTON CA
95210-5607
US

V. Phone/Fax

Practice location:
  • Phone: 209-952-9000
  • Fax: 209-373-1190
Mailing address:
  • Phone: 209-952-9000
  • Fax: 209-373-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DEVIN LARSEN
Title or Position: CEO
Credential:
Phone: 208-340-1840