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
1	1223G0001X	General Practice Dentistry

Other Identifiers

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

General Provider Information

NPI Number	:	1770639437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN DENTAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	750 S INDIAN HILL BLVD STE F
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-5450
Country	:	US
Telephone Number	:	909-625-7395
Fax Number	:	909-625-7812

Provider Business Practice Location Address
First Line	:	750 S INDIAN HILL BLVD STE F
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-5450
Country	:	US
Telephone Number	:	909-625-7395
Fax Number	:	909-625-7812

Authorized Official
Title or Position	:	PPOCOORDINATOR
Name	:	CINDY E AVALOS
Credential	:
Telephone Number	:	714-480-3000

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	08/22/2020

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

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