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General NPI Number Information
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NPI Number | 1427021757
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Entity Type | Organization
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Legal Business Name | ACREE-ISENHOWER DENTAL COPORATION
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 1801 TULLY ROAD SUITE B
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City | MODESTO
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State | CA
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Zip | 95350
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Country | US
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Telephone | 209-343-3500
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Fax | 209-527-1971
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Provider Business Mailing Address
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Address Line | 1801 TULLY ROAD SUITE B
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City | MODESTO
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State | CA
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Zip | 95350
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Country | US
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Telephone | 209-343-3500
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Fax | 209-527-1971
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. COREY ROBERT ACREE
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Credential | DDS
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Telephone | 209-529-0674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 48870
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 48880
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License Number State | CA
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