Provider Demographics
NPI:1295368561
Name:MANUEL M. CONTRERAS DDS A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:MANUEL M. CONTRERAS DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-463-6130
Mailing Address - Street 1:1701 W MARCH LN STE B
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6416
Mailing Address - Country:US
Mailing Address - Phone:209-463-6130
Mailing Address - Fax:209-463-6297
Practice Address - Street 1:1701 W MARCH LN STE B
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6416
Practice Address - Country:US
Practice Address - Phone:209-463-6130
Practice Address - Fax:209-463-6297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental