Healthcare Provider Details

I. General information

NPI: 1174942007
Provider Name (Legal Business Name): TURLOCK DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 DELBON AVE
TURLOCK CA
95382-2019
US

IV. Provider business mailing address

990 DELBON AVE
TURLOCK CA
95382-2019
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-7889
  • Fax: 209-667-4712
Mailing address:
  • Phone: 209-667-7889
  • Fax: 209-667-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number31326
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT A MCCULLA
Title or Position: OWNER
Credential: DDS
Phone: 209-667-7889