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2205 E Palmdale Blvd Palmdale CA 93550-1316 | |
(661) 273-1333 | |
(661) 273-1687 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 2205 E Palmdale Blvd, Palmdale, California |
Authorized Official Name and Position | Leoneed Gordon (PRESIDENT CEO) |
Authorized Official Contact | 6612731333 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2205 E Palmdale Blvd Palmdale CA 93550-1316 Ph: (661) 273-1333 | 2205 E Palmdale Blvd Palmdale CA 93550-1316 Ph: (661) 273-1333 |
NPI Number | 1013134808 |
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Provider Enumeration Date | 04/20/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013134808 | NPI | - | NPPES |
43622 | Other | CA | DENTIST |
32936 | Other | CA | DENTIST |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 32936 (California) | Secondary |
1223G0001X | Dentist - General Practice | 43266 (California) | Primary |