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	:	1841354347
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	:	4123 UNIVERSITY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1418
Country	:	US
Telephone Number	:	619-521-0012
Fax Number	:	619-521-0961

Authorized Official
Title or Position	:	PPO COORDINATOR
Name	:	MRS. MARINA KING
Credential	:
Telephone Number	:	714-480-3000

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1386711901 — DR. RODERICK FAJARDO PANGILINAN
Practice Location Address:

4123 UNIVERSITY AVE
SAN DIEGO, CA
92105-1418

Practice Phone: 619-521-0033
Practice Fax: 619-521-0961

1467520411 — DAVID XUDONG WANG D.D.S
Practice Location Address:

4123 UNIVERSITY AVE
SAN DIEGO, CA
92105-1418

Practice Phone: 619-521-0012
Practice Fax:

1164560884 — DR. JULITA T. TINAMISAN
Practice Location Address:

4123 UNIVERSITY AVE
SAN DIEGO, CA
92105-1418

Practice Phone: 619-521-0012
Practice Fax: 619-521-0961

1851672075 — AMELIA LILLIAN BROADNAX
Practice Location Address:

4101 UNIVERSITY AVE
SAN DIEGO, CA
92105-1418

Practice Phone: 858-609-9073
Practice Fax:

1043679095 — REJUVE-NATIONS OUTPATIENTS FACILITY, INC.
Practice Location Address:

4101 UNIVERSITY AVE , STUITE E204, E205
SAN DIEGO, CA
92105-1418

Practice Phone: 619-602-9405
Practice Fax: 951-657-7180

1669099636 — AMANDA ASHLEY THURMAN FNP
Practice Location Address:

4101 UNIVERSITY AVE
SAN DIEGO, CA
92105-1418

Practice Phone: 619-624-9851
Practice Fax:

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

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.