MEDICARE: SETIAN & SUAREZ DENTAL GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1245889724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SETIAN & SUAREZ DENTAL GROUP, INC

Provider Business Mailing Address
First Line	:	6542 BRIGHT AVE
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90601-4503
Country	:	US
Telephone Number	:	562-693-9263
Fax Number	:

Provider Business Practice Location Address
First Line	:	6542 BRIGHT AVE
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90601-4503
Country	:	US
Telephone Number	:	562-693-9263
Fax Number	:

Authorized Official
Title or Position	:	OWNER / DENTIST
Name	:	RICARDO SUAREZ
Credential	:	DDS
Telephone Number	:	323-363-7771

Provider Enumeration Date	:	09/08/2019
Last Update Date	:	09/08/2019

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