| Grand Orthodontics | |
|
310 E Grand Ave Ste 106 El Segundo CA 90245-3871 | |
| (310) 648-8781 | |
| (310) 648-8776 |
| Full Name | Grand Orthodontics |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 310 E Grand Ave Ste 106, El Segundo, California |
| Authorized Official Name and Position | Kendall Sherron Woolridge (OWNER/DENTIST) |
| Authorized Official Contact | 3106488781 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Orthodontics 310 E Grand Ave Ste 106 El Segundo CA 90245-3871 Ph: (310) 648-8781 | Grand Orthodontics 310 E Grand Ave Ste 106 El Segundo CA 90245-3871 Ph: (310) 648-8781 |
| NPI Number | 1609149533 |
|---|---|
| Provider Enumeration Date | 02/23/2012 |
| Last Update Date | 10/05/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609149533 | NPI | - | NPPES |
| 1104006196 | Other | CA | INDIVIDUAL NPI |
| 1609159533 | Other | CA | TYPE 2 NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 57096 (California) | Primary |
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