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4138 Maine Ave Suite M-2 Baldwin Park CA 91706-3302 | |
| (323) 564-2444 | |
| (323) 923-1088 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 4138 Maine Ave, Baldwin Park, California |
| Authorized Official Name and Position | Liliana Perez (BUSINESS ADMINISTRATOR) |
| Authorized Official Contact | 3235642444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4138 Maine Ave Suite M-2 Baldwin Park CA 91706-3302 Ph: (323) 564-2444 | 4138 Maine Ave Suite M-2 Baldwin Park CA 91706-3302 Ph: (323) 564-2444 |
| NPI Number | 1013300334 |
|---|---|
| Provider Enumeration Date | 03/11/2015 |
| Last Update Date | 03/11/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013300334 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 52676 (California) | Primary |
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