Provider Demographics
NPI:1609041813
Name:DENTAL SURGERY CENTERS OF AMERICA
Entity Type:Organization
Organization Name:DENTAL SURGERY CENTERS OF AMERICA
Other - Org Name:DELTA SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-593-5291
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 1:1523 E MARCH LN STE A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-5607
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:2008-04-29
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG89236Medicaid