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2772 Johnson Dr Suite 101 Ventura CA 93003-8582 | |
| (805) 658-1577 | |
| (805) 658-7049 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2772 Johnson Dr, Ventura, California |
| Authorized Official Name and Position | Gary W. Cooper (SHAREHOLDER/DIRECTOR) |
| Authorized Official Contact | 8056581577 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2772 Johnson Dr Suite 101 Ventura CA 93003-8582 Ph: (805) 658-1577 | 2772 Johnson Dr Suite 101 Ventura CA 93003-8582 Ph: (805) 658-1577 |
| NPI Number | 1972574960 |
|---|---|
| Provider Enumeration Date | 01/30/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972574960 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 26831 (California) | Primary |
| 1223G0001X | Dentist - General Practice | 50370 (California) | Secondary |
Jacob Rider Dds Corporation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2437 Harbor Blvd, Ventura, CA 93001 Phone: 805-804-5590 | |
Nanda Specialists: A Dental Group Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3088 Telegraph Rd Ste A, Ventura, CA 93003 Phone: 907-821-1992 | |
Ventura Dental Specialty Group Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3390 Loma Vista Rd, Suite#c, Ventura, CA 93003 Phone: 805-658-0700 Fax: 805-658-0777 |