Healthcare Provider Details

I. General information

NPI: 1538638796
Provider Name (Legal Business Name): WEST COAST DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12730 HAWTHORNE BLVD STE D
HAWTHORNE CA
90250-3919
US

IV. Provider business mailing address

4415 ARLINGTON AVE
LOS ANGELES CA
90043-1407
US

V. Phone/Fax

Practice location:
  • Phone: 310-220-0914
  • Fax:
Mailing address:
  • Phone: 323-482-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: BHAVIK N BHAKTA
Title or Position: DENTAL HYGIENIST
Credential: RDH
Phone: 323-482-7408