MEDICARE: FARWEST DENTAL GROUP

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	50718	CA

General Provider Information

NPI Number	:	1750700134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARWEST DENTAL GROUP

Provider Business Mailing Address
First Line	:	8880 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-3635
Country	:	US
Telephone Number	:	323-758-6768
Fax Number	:

Provider Business Practice Location Address
First Line	:	8880 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-3635
Country	:	US
Telephone Number	:	323-758-6768
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. ANAS ALKWADRI
Credential	:
Telephone Number	:	310-835-5130

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	04/14/2014

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Directions to “FARWEST DENTAL GROUP ” Practice Location

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