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1029 Elizabeth Lake Rd Palmdale CA 93551 | |
(661) 947-3163 | |
(661) 947-0538 |
Full Name | |
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Speciality | Dentist |
Location | 1029 Elizabeth Lake Rd, Palmdale, California |
Authorized Official Name and Position | Gerald Scott Simmons (OWNER) |
Authorized Official Contact | 6619473163 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1029 Elizabeth Lake Rd Palmdale CA 93551 Ph: (661) 947-3163 | 1029 Elizabeth Lake Rd Palmdale CA 93551 Ph: (661) 947-3163 |
NPI Number | 1912004730 |
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Provider Enumeration Date | 09/20/2006 |
Last Update Date | 02/26/2015 |
Identifier | Type | State | Issuer |
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1912004730 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 31979 (California) | Secondary |
122300000X | Dentist | 29916 (California) | Secondary |
122300000X | Dentist | 24629 (California) | Primary |