Marysol B. Realon DDS a Prof. Dental Corp

NPI #1508023235 in Lathrop, California

Provider Information

NPI Number: 1508023235
Entity Type: Organization
Organization Name: Marysol B. Realon DDS a Prof. Dental Corp
Primary Specialty: Dentist
Enumeration Date: May 20, 2008
Last Updated: May 26, 2015

Practice Location

Address: 259 E. LOUISE AVE
City: Lathrop
State: California
ZIP Code: 95330
Phone: (209) 629-8573

Authorized Official

Name: MRS. MARYSOL B. REALON, DDS
Title: DENTIST
Phone: (209) 629-8573

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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