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450 W Palmdale Blvd Ste D Palmdale CA 93551-3104 | |
(661) 265-7397 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Dental |
Location | 450 W Palmdale Blvd Ste D, Palmdale, California |
Authorized Official Name and Position | Kaveh Kanani (OWNER/DENTIST) |
Authorized Official Contact | 3107109067 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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450 W Palmdale Blvd Ste D Palmdale CA 93551-3104 Ph: (661) 265-7397 | 450 W Palmdale Blvd Ste D Palmdale CA 93551-3104 Ph: (661) 265-7397 |
NPI Number | 1063105237 |
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Provider Enumeration Date | 06/01/2023 |
Last Update Date | 08/03/2023 |
Identifier | Type | State | Issuer |
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1063105237 | NPI | - | NPPES |
1851453518 | Medicaid | CA | |
1023374410 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
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261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |