| Fulbright Dental Group, Pc | |
|
5220 Pacific Concourse Dr Suite #120 Los Angeles CA 90045-6277 | |
| (800) 373-5400 | |
| (888) 492-2900 |
| Full Name | Fulbright Dental Group, Pc |
|---|---|
| Speciality | Dentist |
| Location | 5220 Pacific Concourse Dr, Los Angeles, California |
| Authorized Official Name and Position | Robert S Mathuny (CFO) |
| Authorized Official Contact | 8003735400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fulbright Dental Group, Pc 5220 Pacific Concourse Dr Suite #120 Los Angeles CA 90045-6277 Ph: (800) 373-5400 | Fulbright Dental Group, Pc 5220 Pacific Concourse Dr Suite #120 Los Angeles CA 90045-6277 Ph: (800) 373-5400 |
| NPI Number | 1336384619 |
|---|---|
| Provider Enumeration Date | 12/15/2008 |
| Last Update Date | 10/26/2022 |
| Medicare PECOS PAC ID | 7315253903 |
|---|---|
| Medicare Enrollment ID | O20160125001136 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336384619 | NPI | - | NPPES |
| 47898 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| Provider Name | Abdolreza Saffari Nazari |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1588779144 PECOS PAC ID: 9830234111 Enrollment ID: I20100311000409 |
| Provider Name | Lois R Ledesma |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1184847931 PECOS PAC ID: 4284879826 Enrollment ID: I20130402000021 |
| Provider Name | Son N Vu |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1407045271 PECOS PAC ID: 0244457091 Enrollment ID: I20140819000806 |
| Provider Name | Leonora U Imperial |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1124272406 PECOS PAC ID: 8729206990 Enrollment ID: I20140829001226 |
| Provider Name | David G Varela |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1558548362 PECOS PAC ID: 2668782897 Enrollment ID: I20151030000529 |
| Provider Name | Sarah Gorgees |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1699153742 PECOS PAC ID: 1850688920 Enrollment ID: I20160919000723 |
| Provider Name | Elaine T Dang |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1831457118 PECOS PAC ID: 8325337637 Enrollment ID: I20161123001739 |
| Provider Name | Paul W Johnson |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1588821052 PECOS PAC ID: 0941571731 Enrollment ID: I20191113002231 |
| Provider Name | Jia-kae J Liou |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1447574413 PECOS PAC ID: 7012340748 Enrollment ID: I20191210002225 |
| Provider Name | Jennie M Gutierrez |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1528535515 PECOS PAC ID: 5698135986 Enrollment ID: I20230718003581 |
| Provider Name | Uyen P Pham |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1134638885 PECOS PAC ID: 4688936065 Enrollment ID: I20230718004075 |
| Provider Name | Hannah S Ehrenreich |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1184909491 PECOS PAC ID: 4486015732 Enrollment ID: I20230802002728 |
| Provider Name | Deborah L Van |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1336712074 PECOS PAC ID: 8628430675 Enrollment ID: I20230808003660 |
| Provider Name | Maggie A Bottros |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1760727648 PECOS PAC ID: 5698138238 Enrollment ID: I20230829003381 |
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James C. Castelo, Dds, Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5250 Santa Monica Blvd Ste 210, Los Angeles, CA 90029 Phone: 323-666-3852 | |
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