Provider Demographics
NPI:1407130727
Name:DENTAL SURGERY CENTERS OF AMERICA
Entity Type:Organization
Organization Name:DENTAL SURGERY CENTERS OF AMERICA
Other - Org Name:GRACE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:209-952-9000
Mailing Address - Street 1:1523 E MARCH LN STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-5607
Mailing Address - Country:US
Mailing Address - Phone:209-952-9000
Mailing Address - Fax:209-373-1190
Practice Address - Street 1:1418 E MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4833
Practice Address - Country:US
Practice Address - Phone:209-952-9000
Practice Address - Fax:209-373-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical