Healthcare Provider Details

I. General information

NPI: 1467394999
Provider Name (Legal Business Name): RW MCCOMB DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11058 WASHINGTON BLVD
CULVER CITY CA
90232-3923
US

IV. Provider business mailing address

11058 WASHINGTON BLVD
CULVER CITY CA
90232-3923
US

V. Phone/Fax

Practice location:
  • Phone: 310-299-8894
  • Fax: 424-299-4320
Mailing address:
  • Phone: 310-299-8894
  • Fax: 424-299-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JAQUELYN CERNAS
Title or Position: FINANCIAL MANAGER
Credential:
Phone: 310-299-8894