Provider Demographics
NPI:1962699686
Name:CONTRERAS, MANUEL M (DDS)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:M
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W MARCH LN STE B
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6416
Mailing Address - Country:US
Mailing Address - Phone:209-463-6130
Mailing Address - Fax:209-463-6297
Practice Address - Street 1:1701 W MARCH LN STE B
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6416
Practice Address - Country:US
Practice Address - Phone:209-463-6130
Practice Address - Fax:209-463-6297
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45845122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist