| Academy Dental Center | |
|
628 North Azusa Ave West Covina CA 91791 | |
| (626) 966-8408 | |
| (626) 967-4557 |
| Full Name | Academy Dental Center |
|---|---|
| Speciality | Dentist |
| Location | 628 North Azusa Ave, West Covina, California |
| Authorized Official Name and Position | Stephanie Jung Liu (OWNER) |
| Authorized Official Contact | 6269668408 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Academy Dental Center 628 North Azusa Ave West Covina CA 91791 Ph: (626) 966-8408 | Academy Dental Center 628 North Azusa Ave West Covina CA 91791 Ph: (626) 966-8408 |
| NPI Number | 1629195870 |
|---|---|
| Provider Enumeration Date | 03/23/2007 |
| Last Update Date | 07/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629195870 | NPI | - | NPPES |
| G9075801 | Other | CA | MEDI CAL DENTI CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 122337253 (California) | Primary |
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