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1127 Wilshire Blvd 1504 Los Angeles CA 90017-3901 | |
| (213) 201-1388 | |
| (213) 201-1398 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1127 Wilshire Blvd, Los Angeles, California |
| Authorized Official Name and Position | Steven Vitero (PROGRAM MANAGER) |
| Authorized Official Contact | 2132011388 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1127 Wilshire Blvd 1504 Los Angeles CA 90017-3901 Ph: (213) 201-1388 | 1127 Wilshire Blvd 1504 Los Angeles CA 90017-3901 Ph: (213) 201-1388 |
| NPI Number | 1699979369 |
|---|---|
| Provider Enumeration Date | 06/14/2007 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699979369 | NPI | - | NPPES |
| G0121601 | Other | CA | DENTI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (California) | Primary |
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