Provider Demographics
NPI:1427253384
Name:MOJICA, VINCENT S
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:S
Last Name:MOJICA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E ACACIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1403
Mailing Address - Country:US
Mailing Address - Phone:209-466-0191
Mailing Address - Fax:209-466-3565
Practice Address - Street 1:222 E ACACIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1403
Practice Address - Country:US
Practice Address - Phone:209-466-0191
Practice Address - Fax:209-466-3565
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA466481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice