Provider Demographics
NPI:1376613885
Name:RAY NEPOMUCENO DDS INC
Entity Type:Organization
Organization Name:RAY NEPOMUCENO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:NEPOMVCENO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-529-5886
Mailing Address - Street 1:2020 COFFEE RD
Mailing Address - Street 2:STE B4
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-529-5886
Mailing Address - Fax:209-529-5895
Practice Address - Street 1:2020 COFFEE RD
Practice Address - Street 2:STE B4
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-529-5886
Practice Address - Fax:209-529-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty