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General NPI Number Information
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NPI Number | 1326102823
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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 | 03/20/2018
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Provider Practice Location Address
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Address Line | 2626 MISSION ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-3102
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Country | US
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Telephone | 415-285-7500
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Fax | 415-285-9847
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Provider Business Mailing Address
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Address Line | PO BOX 51022
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City | LOS ANGELES
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State | CA
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Zip | 90051-5322
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Country | US
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Telephone | 714-480-3000
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Fax | 714-571-6445
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Authorized Official
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Title or Position | ENROLLMENT COORDINATOR
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Name | MARIBEL ZAMORA
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Credential |
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Telephone | 714-571-3104
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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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