| Muditajaya Dental Corporation | |
|
9123 Slauson Ave Pico Rivera CA 90660-4522 | |
| (562) 949-0177 | |
| (562) 949-4776 |
| Full Name | Muditajaya Dental Corporation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9123 Slauson Ave, Pico Rivera, California |
| Authorized Official Name and Position | Danny Muditajaya (CEO) |
| Authorized Official Contact | 5629490177 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Muditajaya Dental Corporation 9123 Slauson Ave Pico Rivera CA 90660-4522 Ph: (562) 949-0177 | Muditajaya Dental Corporation 9123 Slauson Ave Pico Rivera CA 90660-4522 Ph: (562) 949-0177 |
| NPI Number | 1942381066 |
|---|---|
| Provider Enumeration Date | 10/17/2006 |
| Last Update Date | 03/09/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942381066 | NPI | - | NPPES |
| G9166001 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30419 (California) | Primary |
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