| St. Jude Dental Clinic | |
|
7758 Knott Ave Buena Park CA 90620-2420 | |
| (714) 522-8723 | |
| Not Available |
| Full Name | St. Jude Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 7758 Knott Ave, Buena Park, California |
| Authorized Official Name and Position | Barry Ross (VICE PRESIDENT, HEALTHY COMMUNITIES) |
| Authorized Official Contact | 7149923164 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Jude Dental Clinic 7758 Knott Ave Buena Park CA 90620-2420 Ph: (714) 522-8723 | St. Jude Dental Clinic 7758 Knott Ave Buena Park CA 90620-2420 Ph: (714) 522-8723 |
| NPI Number | 1063534501 |
|---|---|
| Provider Enumeration Date | 04/04/2007 |
| Last Update Date | 11/28/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063534501 | NPI | - | NPPES |
| 70894F | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (California) | Primary |
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