| Mact Dental, Angels Camp | |
|
52 S Main Street, Suite B Angels Camp CA 95222 | |
| (209) 754-6262 | |
| Not Available |
| Full Name | Mact Dental, Angels Camp |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 52 S Main Street, Suite B, Angels Camp, California |
| Authorized Official Name and Position | John Shawver Alexander (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2097546258 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mact Dental, Angels Camp Po Box 939 Angels Camp CA 95222-0939 Ph: (209) 754-6262 | Mact Dental, Angels Camp 52 S Main Street, Suite B Angels Camp CA 95222 Ph: (209) 754-6262 |
| NPI Number | 1417505918 |
|---|---|
| Provider Enumeration Date | 08/28/2019 |
| Last Update Date | 11/17/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417505918 | NPI | - | NPPES |
| 1366519431 | Other | CA | FQHC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |