| Central Dental Care | |
|
2023 Beverly Blvd Los Angeles CA 90057-2417 | |
| (213) 353-9930 | |
| (213) 353-0990 |
| Full Name | Central Dental Care |
|---|---|
| Speciality | Dentist |
| Location | 2023 Beverly Blvd, Los Angeles, California |
| Authorized Official Name and Position | Celia Ponce Octoman (PRESIDENT) |
| Authorized Official Contact | 2133539930 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Dental Care 2023 Beverly Blvd Los Angeles CA 90057-2417 Ph: (213) 353-9930 | Central Dental Care 2023 Beverly Blvd Los Angeles CA 90057-2417 Ph: (213) 353-9930 |
| NPI Number | 1750431516 |
|---|---|
| Provider Enumeration Date | 01/11/2007 |
| Last Update Date | 02/08/2008 |
| Medicare PECOS PAC ID | 3375970874 |
|---|---|
| Medicare Enrollment ID | O20200221002500 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750431516 | NPI | - | NPPES |
| D30490 | Other | CA | DENTICAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30490 (California) | Primary |
| Provider Name | Celia Ponce Octoman |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1790963890 PECOS PAC ID: 4284061789 Enrollment ID: I20200224000027 |
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