Healthcare Provider Details

I. General information

NPI: 1497090500
Provider Name (Legal Business Name): CARE DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23517 MAIN ST STE 106
CARSON CA
90745-5237
US

IV. Provider business mailing address

23517 MAIN ST STE 106
CARSON CA
90745-5237
US

V. Phone/Fax

Practice location:
  • Phone: 310-513-0222
  • Fax: 310-513-1352
Mailing address:
  • Phone: 310-513-0222
  • Fax: 310-513-1352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number25406
License Number StateCA

VIII. Authorized Official

Name: SANFORD KAPLAN
Title or Position: DENTIST
Credential:
Phone: 310-513-0222