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5555 Del Amo Blvd Lakewood CA 90713-2307 | |
| (562) 866-1735 | |
| (562) 866-8190 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 5555 Del Amo Blvd, Lakewood, California |
| Authorized Official Name and Position | Robert K Goodis (OWNER) |
| Authorized Official Contact | 5628661735 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5555 Del Amo Blvd Lakewood CA 90713-2307 Ph: (562) 866-1735 | 5555 Del Amo Blvd Lakewood CA 90713-2307 Ph: (562) 866-1735 |
| NPI Number | 1790999340 |
|---|---|
| Provider Enumeration Date | 05/10/2007 |
| Last Update Date | 07/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790999340 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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