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General NPI Number Information
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NPI Number | 1750700134
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Entity Type | Organization
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Legal Business Name | FARWEST DENTAL GROUP
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 8880 S BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90003-3635
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Country | US
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Telephone | 323-758-6768
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Fax |
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Provider Business Mailing Address
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Address Line | 8880 S BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90003-3635
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Country | US
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Telephone | 323-758-6768
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. ANAS ALKWADRI
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Credential |
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Telephone | 310-835-5130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 50718
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License Number State | CA
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