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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 : 1639221484
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 : 975 VETERANS BLVD
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94063-1714
Country : US
Telephone Number : 650-365-8900
Fax Number : 650-365-1546
Authorized Official
Title or Position : PPO COORDINATOR
Name : MRS. MARINA KING
Credential :
Telephone Number : 714-480-3000
Provider Enumeration Date : 01/18/2007
Last Update Date : 08/22/2020

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

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