|
| |
|
5714 Atlantic Blvd Maywood CA 90270-2920 | |
| (323) 581-4008 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5714 Atlantic Blvd, Maywood, California |
| Authorized Official Name and Position | James T Wong (DENTIST) |
| Authorized Official Contact | 3235814008 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5714 Atlantic Blvd Maywood CA 90270-2920 Ph: (323) 581-4008 | 5714 Atlantic Blvd Maywood CA 90270-2920 Ph: (323) 581-4008 |
| NPI Number | 1306999651 |
|---|---|
| Provider Enumeration Date | 01/19/2007 |
| Last Update Date | 06/11/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306999651 | NPI | - | NPPES |
| G93151-01 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 42713 (California) | Primary |
Western Dental Services, Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 4487 Slauson Ave, Maywood, CA 90270 Phone: 323-773-9961 Fax: 323-773-6235 |