| Dr. Lance C. Bautista Pediatric Dentistry | |
|
1213 Coffee Rd Ste E Modesto CA 95355-4229 | |
| (209) 523-5437 | |
| (209) 523-5436 |
| Full Name | Dr. Lance C. Bautista Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1213 Coffee Rd Ste E, Modesto, California |
| Authorized Official Name and Position | Lance C. Bautista (CEO, PRESIDENT) |
| Authorized Official Contact | 2095235437 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Lance C. Bautista Pediatric Dentistry 1213 Coffee Rd Ste E Modesto CA 95355-4229 Ph: (209) 523-5437 | Dr. Lance C. Bautista Pediatric Dentistry 1213 Coffee Rd Ste E Modesto CA 95355-4229 Ph: (209) 523-5437 |
| NPI Number | 1730742701 |
|---|---|
| Provider Enumeration Date | 04/16/2019 |
| Last Update Date | 04/16/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730742701 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | () | Primary |
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