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General NPI Number Information
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NPI Number | 1942423918
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Entity Type | Organization
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Legal Business Name | CASTAIC DENTAL CENTER
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 31886 N CASTAIC RD
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City | CASTAIC
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State | CA
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Zip | 91384
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Country | US
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Telephone | 661-257-2300
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Fax | 661-257-2980
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Provider Business Mailing Address
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Address Line | 21700 W GOLDEN TRIANGLE RD #201
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City | SAUGUS
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State | CA
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Zip | 91350
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Country | US
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Telephone | 661-259-5540
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Fax | 661-259-5571
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. GEORGE WARREN EKINS
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Credential | DDS
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Telephone | 661-259-5540
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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 | 18821
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License Number State | CA
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