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General NPI Number Information
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NPI Number | 1154485654
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Entity Type | Organization
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Legal Business Name | WESTERN DENTAL SERVICES, INC.
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 1616 FRANKLIN ST STE 100
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City | OAKLAND
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State | CA
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Zip | 94612-2830
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Country | US
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Telephone | 510-251-1000
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Fax | 510-251-9264
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Provider Business Mailing Address
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Address Line | 530 S MAIN ST
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City | ORANGE
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State | CA
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Zip | 92868-4525
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Country | US
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Telephone | 714-480-3000
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Fax | 714-571-3560
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | PREET TAKKAR
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Credential |
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Telephone | 714-571-3372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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