Healthcare Provider Details

I. General information

NPI: 1467519819
Provider Name (Legal Business Name): CHESLEY R HOUSKE JR., DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W CARSON ST
CARSON CA
90745-2608
US

IV. Provider business mailing address

27401 EASTVALE RD
ROLLING HILLS ESTATES CA
90274-4018
US

V. Phone/Fax

Practice location:
  • Phone: 310-787-7053
  • Fax: 310-787-8182
Mailing address:
  • Phone: 310-787-7053
  • Fax: 310-787-8182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32425
License Number StateCA

VIII. Authorized Official

Name: ELOISA TAPIA
Title or Position: OFFICE MANAGER
Credential:
Phone: 310-787-7053