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General NPI Number Information
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NPI Number | 1346603487
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Entity Type | Organization
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Legal Business Name | B.G. BEDFORD,D.D.S.
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 808 E MANCHESTER BLVD
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City | INGLEWOOD
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State | CA
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Zip | 90301-1914
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Country | US
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Telephone | 310-671-6191
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Fax | 310-338-1249
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Provider Business Mailing Address
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Address Line | 808 E MANCHESTER BLVD P.O. BOX 1786
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City | INGLEWOOD
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State | CA
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Zip | 90301-1914
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Country | US
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Telephone | 310-671-6191
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Fax | 310-338-1249
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Authorized Official
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Title or Position | GENERAL DENTISTRY SINGLE PROPRIETOR
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Name | DR. BILLY G. BEDFORD
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Credential | D.D.S.
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Telephone | 310-671-6191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 27955
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License Number State | CA
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