Provider Demographics
NPI:1700060514
Name:COUNTY OF SAN JOAQUIN
Entity Type:Organization
Organization Name:COUNTY OF SAN JOAQUIN
Other - Org Name:DENTAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FCCP, FACP
Authorized Official - Phone:209-468-6600
Mailing Address - Street 1:PO BOX 1020
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95201-3120
Mailing Address - Country:US
Mailing Address - Phone:209-468-6600
Mailing Address - Fax:209-468-7042
Practice Address - Street 1:500 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-9693
Practice Address - Country:US
Practice Address - Phone:209-468-6600
Practice Address - Fax:209-468-7042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN JOAQUIN GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-28
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000087261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG01021-01OtherDENTI-CAL