| Mc Arthur Park Dental Office | |
|
2007 Wilshire Blvd Los Angeles CA 90057-3506 | |
| (213) 928-7297 | |
| (310) 274-6067 |
| Full Name | Mc Arthur Park Dental Office |
|---|---|
| Speciality | Dentist |
| Location | 2007 Wilshire Blvd, Los Angeles, California |
| Authorized Official Name and Position | Andrei Souchitski (OWNER) |
| Authorized Official Contact | 2138584007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mc Arthur Park Dental Office 2007 Wilshire Blvd. Suite 525 Los Angeles CA 90057 Ph: (213) 858-4007 | Mc Arthur Park Dental Office 2007 Wilshire Blvd Los Angeles CA 90057-3506 Ph: (213) 928-7297 |
| NPI Number | 1417349556 |
|---|---|
| Provider Enumeration Date | 02/26/2015 |
| Last Update Date | 11/04/2019 |
| Medicare PECOS PAC ID | 2062844624 |
|---|---|
| Medicare Enrollment ID | O20191120000536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417349556 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 43249 (California) | Primary |
| Provider Name | Andrei Souchitski |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1265543920 PECOS PAC ID: 3678863065 Enrollment ID: I20191120000407 |
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