Provider Demographics
NPI:1417421256
Name:DENTAL SURGERY CENTERS OF AMERICA
Entity type:Organization
Organization Name:DENTAL SURGERY CENTERS OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-340-1840
Mailing Address - Street 1:1523 EAST MARCH LANE
Mailing Address - Street 2:SUITE A
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 1:145 SOUTH NEWMARK AVE
Practice Address - Street 2:
Practice Address - City:PARLIER
Practice Address - State:CA
Practice Address - Zip Code:93648-2531
Practice Address - Country:US
Practice Address - Phone:559-646-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical