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General NPI Number Information
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NPI Number | 1790123966
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Entity Type | Organization
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Legal Business Name | WESTCOAST DENTAL
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 06/11/2013
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Provider Practice Location Address
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Address Line | 12730 HAWTHORNE BLVD STE D
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City | HAWTHORNE
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State | CA
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Zip | 90250-3919
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Country | US
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Telephone | 310-644-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 12121 WILSHIRE BLVD STE 1111
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City | LOS ANGELES
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State | CA
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Zip | 90025-1188
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MR. MIGUEL REYES
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Credential |
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Telephone | 310-820-9933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 25300
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License Number State | CA
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