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1730 S Victoria Ave Ste 250 Ventura CA 93003-6167 | |
| (805) 650-1080 | |
| (805) 650-1087 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1730 S Victoria Ave Ste 250, Ventura, California |
| Authorized Official Name and Position | Adam Gary Lautt (PRESIDENT) |
| Authorized Official Contact | 8056501080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1730 S Victoria Ave Ste 250 Ventura CA 93003-6167 Ph: (805) 650-1080 | 1730 S Victoria Ave Ste 250 Ventura CA 93003-6167 Ph: (805) 650-1080 |
| NPI Number | 1740325836 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740325836 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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