Healthcare Provider Details

I. General information

NPI: 1891174009
Provider Name (Legal Business Name): ANTHONY DUNCAN DDS DOMINGUEZ HILLS DENTAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20930 BONITA ST STE T
CARSON CA
90746-3686
US

IV. Provider business mailing address

20930 BONITA ST STE T
CARSON CA
90746-3686
US

V. Phone/Fax

Practice location:
  • Phone: 310-515-1490
  • Fax:
Mailing address:
  • Phone: 310-515-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number34086
License Number StateCA

VIII. Authorized Official

Name: DR. ANTHONY DUNCAN
Title or Position: CEO
Credential: D.D.S.
Phone: 310-515-1490