| Ofelia K. Costales, D.d.s., Inc. | |
|
23517 South Main St Ste 102 Carson CA 90745 | |
| (310) 518-6802 | |
| Not Available |
| Full Name | Ofelia K. Costales, D.d.s., Inc. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 23517 South Main St Ste 102, Carson, California |
| Authorized Official Name and Position | Ofelia Karaan Costales (PRESIDENT/OWNER) |
| Authorized Official Contact | 3105186802 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ofelia K. Costales, D.d.s., Inc. 23517 South Main St Ste 102 Carson CA 90745 Ph: (310) 518-6802 | Ofelia K. Costales, D.d.s., Inc. 23517 South Main St Ste 102 Carson CA 90745 Ph: (310) 518-6802 |
| NPI Number | 1043575798 |
|---|---|
| Provider Enumeration Date | 07/09/2012 |
| Last Update Date | 07/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043575798 | NPI | - | NPPES |
| 522096 | Other | CA | DENTICAL PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 48250 (California) | Primary |
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