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500 S Sepulveda Blvd Ste 301 Manhattan Beach CA 90266-6976 | |
| (310) 683-5576 | |
| (310) 683-4648 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 500 S Sepulveda Blvd Ste 301, Manhattan Beach, California |
| Authorized Official Name and Position | Tera Van Houten (PARTNER) |
| Authorized Official Contact | 3107750645 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
500 S Sepulveda Blvd Ste 301 Manhattan Beach CA 90266-6976 Ph: (310) 683-5576 | 500 S Sepulveda Blvd Ste 301 Manhattan Beach CA 90266-6976 Ph: (310) 683-5576 |
| NPI Number | 1982132239 |
|---|---|
| Provider Enumeration Date | 05/31/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982132239 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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