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NPI Code Detail

MEDICARE: WESTERN DENTAL SERVICES, INC.

MEDICARE: WESTERN DENTAL SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225190135
Entity Type Code : Organization
Provider Name (Legal Business Name) : WESTERN DENTAL SERVICES, INC.
Provider Business Mailing Address
First Line : 530 S MAIN ST
Second Line :
City : ORANGE
State : CA
Zip : 92868-4525
Country : US
Telephone Number : 714-480-3000
Fax Number : 714-571-3560
Provider Business Practice Location Address
First Line : 4165 BEVERLY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-4418
Country : US
Telephone Number : 323-662-0738
Fax Number : 323-662-1602
Authorized Official
Title or Position : CHIEF INFORMATION OFFICER
Name : PREET TAKKAR
Credential :
Telephone Number : 714-571-3372
Provider Enumeration Date : 12/15/2006
Last Update Date : 10/28/2019

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Directions to “WESTERN DENTAL SERVICES, INC. ” Practice Location

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