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General NPI Number Information
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NPI Number | 1891180642
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Entity Type | Organization
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Legal Business Name | DIKO A DIKO
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 3848 MCHENRY AVE STE 130
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City | MODESTO
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State | CA
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Zip | 95356-1599
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Country | US
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Telephone | 209-523-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 3848 MCHENRY AVE STE 130
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City | MODESTO
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State | CA
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Zip | 95356-1599
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Country | US
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Telephone | 209-523-2100
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | DIKO A DIKO
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Credential |
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Telephone | 209-523-2100
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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 | 49511
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License Number State | CA
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