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General NPI Number Information
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NPI Number | 1356724587
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Entity Type | Organization
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Legal Business Name | A DENTAL GROUP OF WILLIAM E. VICKERMAN DDS
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 18000 STUDEBAKER RD STE 365
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City | CERRITOS
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State | CA
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Zip | 90703-2690
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Country | US
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Telephone | 562-202-5741
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Fax |
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Provider Business Mailing Address
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Address Line | 18000 STUDEBAKER RD STE 365
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City | CERRITOS
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State | CA
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Zip | 90703-2690
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Country | US
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Telephone | 562-202-5741
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MR. BENSON B. DIMARANAN
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Credential | BSC, RPHT, RDA, OAP
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Telephone | 562-202-5741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 27704
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License Number State | CA
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