Healthcare Provider Details

I. General information

NPI: 1740333830
Provider Name (Legal Business Name): WESTERN DENTAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2091 W FLORIDA AVE STE 100
HEMET CA
92545-4800
US

IV. Provider business mailing address

PO BOX 51022
LOS ANGELES CA
90051-5322
US

V. Phone/Fax

Practice location:
  • Phone: 951-929-2222
  • Fax: 951-929-2793
Mailing address:
  • Phone: 714-480-3000
  • Fax: 714-571-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MARIBEL ZAMORA
Title or Position: ENROLLMENT COORDINATOR
Credential:
Phone: 714-571-3104