Provider Demographics
NPI:1972549103
Name:STREET, DAVID CAREY (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CAREY
Last Name:STREET
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 1:2200 MCHENRY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-3256
Mailing Address - Country:US
Mailing Address - Phone:209-526-9132
Mailing Address - Fax:209-526-9131
Practice Address - Street 1:2200 MCHENRY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3256
Practice Address - Country:US
Practice Address - Phone:209-526-9132
Practice Address - Fax:209-526-9131
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 308481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice