MEDICARE: WESTERN DENTAL SERVICES, 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	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518191006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN DENTAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	530 S MAIN ST
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4525
Country	:	US
Telephone Number	:	714-480-3000
Fax Number	:	714-571-3698

Provider Business Practice Location Address
First Line	:	555 S SUNRISE WAY
Second Line	:	SUITE #400
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-7869
Country	:	US
Telephone Number	:	760-322-6061
Fax Number	:	760-322-2018

Authorized Official
Title or Position	:	ASSISTANT MANAGER
Name	:	CINDY E. AVALOS
Credential	:
Telephone Number	:	714-480-3000

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	05/12/2009

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Directions to “WESTERN DENTAL SERVICES, INC. ” Practice Location

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