| El Centro Dental Group | |
|
617 S 8th St El Centro CA 92243-3218 | |
| (760) 312-5888 | |
| (760) 312-5918 |
| Full Name | El Centro Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 617 S 8th St, El Centro, California |
| Authorized Official Name and Position | David S Park (OWNER) |
| Authorized Official Contact | 3104031117 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| El Centro Dental Group 617 S 8th St El Centro CA 92243-3218 Ph: (760) 312-5888 | El Centro Dental Group 617 S 8th St El Centro CA 92243-3218 Ph: (760) 312-5888 |
| NPI Number | 1346659562 |
|---|---|
| Provider Enumeration Date | 08/13/2014 |
| Last Update Date | 12/04/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346659562 | NPI | - | NPPES |
| 53724 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 53724 (California) | Primary |
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