MEDICARE: CYPRESS DENTAL CLINIC

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	:	1861916900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYPRESS DENTAL CLINIC

Provider Business Mailing Address
First Line	:	2135 CYPRESS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-1212
Country	:	US
Telephone Number	:	323-223-0731
Fax Number	:	323-223-0775

Provider Business Practice Location Address
First Line	:	2135 CYPRESS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-1212
Country	:	US
Telephone Number	:	323-223-0731
Fax Number	:	323-223-0775

Authorized Official
Title or Position	:	OWNER
Name	:	DIPTI D ACHHNANI
Credential	:	DDS
Telephone Number	:	323-223-0731

Provider Enumeration Date	:	07/31/2017
Last Update Date	:	07/21/2022

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Directions to “CYPRESS DENTAL CLINIC ” Practice Location

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