| |
4354 Tweedy Blvd South Gate CA 90280-6237 | |
(323) 564-2444 | |
(323) 249-7565 |
Full Name | |
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Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
Location | 4354 Tweedy Blvd, South Gate, California |
Authorized Official Name and Position | Jerry David Minsky (OWNER) |
Authorized Official Contact | 3235642444 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4354 Tweedy Blvd South Gate CA 90280-6237 Ph: (323) 564-2444 | 4354 Tweedy Blvd South Gate CA 90280-6237 Ph: (323) 564-2444 |
NPI Number | 1194928614 |
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Provider Enumeration Date | 06/11/2007 |
Last Update Date | 09/16/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1194928614 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 31668 (California) | Primary |
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