| Antelope Valley Dental Group | |
|
1037 E Palmdale Blvd Ste 203 Palmdale CA 93550-4745 | |
| (661) 272-9181 | |
| (661) 272-8932 |
| Full Name | Antelope Valley Dental Group |
|---|---|
| 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 |
|---|---|
| Antelope Valley Dental Group 1037 E Palmdale Blvd Ste 203 Palmdale CA 93550-4745 Ph: (661) 272-9181 | Antelope Valley Dental Group 1037 E Palmdale Blvd Ste 203 Palmdale CA 93550-4745 Ph: (661) 272-9181 |
| NPI Number | 1275950818 |
|---|---|
| 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 |
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