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General NPI Number Information
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NPI Number | 1902942014
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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 | 01/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 791 E MONTE VISTA AVE
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City | VACAVILLE
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State | CA
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Zip | 95688-2920
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Country | US
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Telephone | 707-359-2211
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Fax | 707-452-8114
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Provider Business Mailing Address
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Address Line | 530 S MAIN ST
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City | ORANGE
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State | CA
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Zip | 92868-4525
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Country | US
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Telephone | 714-480-3000
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Fax | 714-571-3560
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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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