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35952 Winchester Rd Bldg 2 Winchester CA 92596-7537 | |
| (310) 820-9933 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 35952 Winchester Rd Bldg 2, Winchester, California |
| Authorized Official Name and Position | Miguel Reyes (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 3104094225 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12121 Wilshire Blvd Ste 1111 Los Angeles CA 90025-1188 Ph: (310) 820-9933 | 35952 Winchester Rd Bldg 2 Winchester CA 92596-7537 Ph: (310) 820-9933 |
| NPI Number | 1902538812 |
|---|---|
| Provider Enumeration Date | 06/29/2022 |
| Last Update Date | 03/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902538812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
Dental Corporation Of Kyle Poulsen Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 32897 Western Hills Dr, Suite 103, Winchester, CA 92596 Phone: 951-335-5169 Fax: 951-213-4675 |