| Marysol B. Realon Dds A Prof. Dental Corp | |
|
259 E. Louise Ave Lathrop CA 95330 | |
| (209) 629-8573 | |
| (209) 629-8574 |
| Full Name | Marysol B. Realon Dds A Prof. Dental Corp |
|---|---|
| Speciality | Dentist |
| Location | 259 E. Louise Ave, Lathrop, California |
| Authorized Official Name and Position | Marysol B. Realon (DENTIST) |
| Authorized Official Contact | 2096298573 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marysol B. Realon Dds A Prof. Dental Corp 259 E. Louise Ave Lathrop CA 95330 Ph: (209) 629-8573 | Marysol B. Realon Dds A Prof. Dental Corp 259 E. Louise Ave Lathrop CA 95330 Ph: (209) 629-8573 |
| NPI Number | 1508023235 |
|---|---|
| Provider Enumeration Date | 05/20/2008 |
| Last Update Date | 05/26/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508023235 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 53855 (California) | Primary |
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