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General NPI Number Information
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NPI Number | 1366172033
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Entity Type | Organization
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Legal Business Name | PHILLIP HA DENTAL CORPORATION
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 10/22/2022
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Provider Practice Location Address
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Address Line | 1700 MCHENRY AVE STE 16B
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City | MODESTO
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State | CA
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Zip | 95350-4319
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Country | US
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Telephone | 209-238-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 MCHENRY AVE STE 16B
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City | MODESTO
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State | CA
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Zip | 95350-4319
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Country | US
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Telephone | 209-238-9800
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. PHILLIP HA
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Credential | DDS, MS
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Telephone | 626-482-6159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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