| Farwest Dental Group, Pc | |
|
1704 N Avalon Blvd Wilmington CA 90744-1433 | |
| (310) 835-5030 | |
| (310) 835-6090 |
| Full Name | Farwest Dental Group, Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1704 N Avalon Blvd, Wilmington, California |
| Authorized Official Name and Position | Hassan Fayoumi (CEO) |
| Authorized Official Contact | 3106991549 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Farwest Dental Group, Pc 1704 N Avalon Blvd Wilmington CA 90744-1433 Ph: (310) 835-5030 | Farwest Dental Group, Pc 1704 N Avalon Blvd Wilmington CA 90744-1433 Ph: (310) 835-5030 |
| NPI Number | 1023598836 |
|---|---|
| Provider Enumeration Date | 08/21/2018 |
| Last Update Date | 08/21/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023598836 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 52604 (California) | Primary |
| 261QD0000X | Clinic/center - Dental | 50718 (California) | Secondary |
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