MEDICARE: NARVAEZ DDS, A PROFESSIONAL DENTAL CORPORATION

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
1	302F00000X	Exclusive Provider Organization	56354	CA

General Provider Information

NPI Number	:	1245580778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NARVAEZ DDS, A PROFESSIONAL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1379 WEST PARK WESTERN DR. #517
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90732-2300
Country	:	US
Telephone Number	:	310-530-3100
Fax Number	:	310-530-3103

Provider Business Practice Location Address
First Line	:	2055 LOMITA BLVD
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717-1701
Country	:	US
Telephone Number	:	310-530-3100
Fax Number	:	310-530-3103

Authorized Official
Title or Position	:	PRESIDENT/CEO/DENTIST
Name	:	MRS. ARELVIS ALEJANDRINA NARVAEZ-MOORE
Credential	:	DDS
Telephone Number	:	310-530-3100

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	05/31/2019

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