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General NPI Number Information
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NPI Number | 1417261132
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Entity Type | Organization
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Legal Business Name | EVEREST DENTAL CARE INC
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 2050 S. CENTRAL AVE.
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City | LOS ANGELES
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State | CA
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Zip | 90011
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Country | US
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Telephone | 323-423-5860
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17665
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City | BEVERLY HILLS
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State | CA
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Zip | 90209-3665
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Country | US
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Telephone | 323-423-5860
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUAN POCHOLO B CANCIO
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Credential | DDS
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Telephone | 323-423-5860
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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 | 56585
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License Number State | CA
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