Healthcare Provider Details

I. General information

NPI: 1306362876
Provider Name (Legal Business Name): WESTERN DENTAL SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15634 WHITTWOOD LN
WHITTIER CA
90603-2324
US

IV. Provider business mailing address

530 S MAIN ST
ORANGE CA
92868-4525
US

V. Phone/Fax

Practice location:
  • Phone: 562-501-1800
  • Fax: 714-571-6445
Mailing address:
  • Phone: 714-480-3000
  • Fax: 714-571-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: PREET TAKKAR
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 714-571-3372