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General NPI Number Information
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NPI Number | 1881347987
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Entity Type | Organization
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Legal Business Name | VON WESTERNHAGEN DENTAL CORPORATION
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Dates
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Enumeration Date | 01/28/2022
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 10804 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90047-4629
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Country | US
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Telephone | 312-274-4581
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Fax |
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Provider Business Mailing Address
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Address Line | 350 N CLARK ST STE 600
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City | CHICAGO
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State | IL
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Zip | 60654-4782
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Country | US
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Telephone | 312-274-4581
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Fax |
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Authorized Official
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Title or Position | LEAD PROVIDER RELATIONS SPECIALIST
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Name | ERICKA SOTO
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Credential |
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Telephone | 312-274-4581
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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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