El Segundo Modern Dentistry | |
310 E Grand Ave Ste 102 El Segundo CA 90245-3871 | |
(424) 277-1138 | |
Not Available |
Full Name | El Segundo Modern Dentistry |
---|---|
Speciality | Clinic/center - Dental |
Location | 310 E Grand Ave Ste 102, El Segundo, California |
Authorized Official Name and Position | Omid R Barkhordar (OWNER) |
Authorized Official Contact | 4242771138 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
El Segundo Modern Dentistry 310 E Grand Ave Ste 102 El Segundo CA 90245-3871 Ph: (424) 277-1138 | El Segundo Modern Dentistry 310 E Grand Ave Ste 102 El Segundo CA 90245-3871 Ph: (424) 277-1138 |
NPI Number | 1396260972 |
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Provider Enumeration Date | 08/04/2017 |
Last Update Date | 07/21/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396260972 | NPI | - | NPPES |
1538607965 | Other | CA | NPI |
1821229444 | Other | CA | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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