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General NPI Number Information
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NPI Number | 1770639437
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Entity Type | Organization
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Legal Business Name | WESTERN DENTAL SERVICES, INC.
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 750 S INDIAN HILL BLVD STE F
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City | CLAREMONT
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State | CA
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Zip | 91711-5450
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Country | US
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Telephone | 909-625-7395
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Fax | 909-625-7812
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Provider Business Mailing Address
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Address Line | 750 S INDIAN HILL BLVD STE F
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City | CLAREMONT
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State | CA
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Zip | 91711-5450
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Country | US
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Telephone | 909-625-7395
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Fax | 909-625-7812
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Authorized Official
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Title or Position | PPOCOORDINATOR
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Name | CINDY E AVALOS
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Credential |
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Telephone | 714-480-3000
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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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