MEDICARE: COMMUNITY DENTAL SERVICES

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

General Provider Information

NPI Number	:	1659442838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY DENTAL SERVICES

Provider Business Mailing Address
First Line	:	2 MACARTHUR PL
Second Line	:	SUITE 700
City	:	SANTA ANA
State	:	CA
Zip	:	92707-5924
Country	:	US
Telephone Number	:	714-708-5308
Fax Number	:	714-708-5399

Provider Business Practice Location Address
First Line	:	12233 CENTRAL AVE
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-2423
Country	:	US
Telephone Number	:	909-628-0208
Fax Number	:	909-627-3372

Authorized Official
Title or Position	:	CONTRACT SUPERVISOR
Name	:	MRS. ELAINE SALCIDO
Credential	:
Telephone Number	:	714-708-5308

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	08/22/2020

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