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1037 E Palmdale Blvd Ste 203 Palmdale CA 93550-4745 | |
(661) 272-9181 | |
(661) 272-8932 |
Full Name | |
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Speciality | Dentist |
Location | 1037 E Palmdale Blvd Ste 203, Palmdale, California |
Authorized Official Name and Position | David S Park (OWNER) |
Authorized Official Contact | 3104031117 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1037 E Palmdale Blvd Ste 203 Palmdale CA 93550-4745 Ph: (661) 272-9181 | 1037 E Palmdale Blvd Ste 203 Palmdale CA 93550-4745 Ph: (661) 272-9181 |
NPI Number | 1275950818 |
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Provider Enumeration Date | 03/20/2014 |
Last Update Date | 07/27/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275950818 | NPI | - | NPPES |
53724 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 53724 (California) | Primary |
1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |