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General NPI Number Information
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NPI Number | 1770762965
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Entity Type | Organization
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Legal Business Name | THE CHILDREN'S DENTAL HEALTH CLINIC
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 10005 FLOWER ST
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City | BELLFLOWER
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State | CA
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Zip | 90706-5412
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Country | US
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Telephone | 562-804-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 10005 FLOWER ST
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City | BELLFLOWER
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State | CA
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Zip | 90706-5412
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Country | US
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Telephone | 562-804-8100
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Fax |
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Authorized Official
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Title or Position | DENTAL DIRECTOR
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Name | DR. JOHN BLAKE
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Credential | D.D.S.
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Telephone | 562-933-3141
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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 | D36731
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D36731
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | D36731
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D36731
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License Number State | CA
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