| 17th Street Modern Dentistry Dental Group | |
|
270 E 17th St Ste 15 Costa Mesa CA 92627-3845 | |
| (714) 224-0480 | |
| (714) 224-0480 |
| Full Name | 17th Street Modern Dentistry Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 270 E 17th St Ste 15, Costa Mesa, California |
| Authorized Official Name and Position | Clint Walker (OWNER) |
| Authorized Official Contact | 7142240480 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 17th Street Modern Dentistry Dental Group Po Box 920050 Dallas TX 75392-0050 Ph: () - | 17th Street Modern Dentistry Dental Group 270 E 17th St Ste 15 Costa Mesa CA 92627-3845 Ph: (714) 224-0480 |
| NPI Number | 1790273829 |
|---|---|
| Provider Enumeration Date | 04/24/2018 |
| Last Update Date | 05/11/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790273829 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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