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General NPI Number Information
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NPI Number | 1427625581
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Entity Type | Organization
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Legal Business Name | HANAWALT WES DENTAL CORPORATION
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 2450 D ST
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City | LA VERNE
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State | CA
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Zip | 91750-4416
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Country | US
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Telephone | 909-593-4581
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 D ST
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City | LA VERNE
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State | CA
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Zip | 91750-4416
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Country | US
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Telephone | 909-593-4581
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. PERI LYNN HANAWALT WES
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Credential | DMD
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Telephone | 909-238-0395
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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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