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General NPI Number Information
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NPI Number | 1811731169
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Entity Type | Organization
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Legal Business Name | SP STOCKTON ENDODONTICS PARTNERSHIP
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Dates
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Enumeration Date | 06/21/2024
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 3133 W MARCH LN STE 2030
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City | STOCKTON
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State | CA
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Zip | 95219-2361
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Country | US
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Telephone | 209-901-4376
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Fax |
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Provider Business Mailing Address
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Address Line | 3133 W MARCH LN STE 2030
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City | STOCKTON
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State | CA
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Zip | 95219-2361
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | MATTHEW WILLIAM HATZKE
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Credential |
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Telephone | 408-234-5434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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