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4138 Maine Ave Ste M2 Baldwin Park CA 91706-3302 | |
| (310) 795-3363 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4138 Maine Ave Ste M2, Baldwin Park, California |
| Authorized Official Name and Position | Tharwat Sorour (PRESIDENT) |
| Authorized Official Contact | 3107953363 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4138 Maine Ave Ste M2 Baldwin Park CA 91706-3302 Ph: (310) 795-3363 | 4138 Maine Ave Ste M2 Baldwin Park CA 91706-3302 Ph: (310) 795-3363 |
| NPI Number | 1063926137 |
|---|---|
| Provider Enumeration Date | 11/27/2017 |
| Last Update Date | 11/27/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063926137 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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