St.john Dental | |
910 E Gladstone St Azusa CA 91702-4747 | |
(626) 332-3000 | |
(626) 332-3001 |
Full Name | St.john Dental |
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Speciality | Clinic/Center |
Location | 910 E Gladstone St, Azusa, California |
Authorized Official Name and Position | Atef Edward Gindy Hana (DENTIST) |
Authorized Official Contact | 6263323000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
St.john Dental 910 E Gladstone St Azusa CA 91702-4747 Ph: (626) 332-3000 | St.john Dental 910 E Gladstone St Azusa CA 91702-4747 Ph: (626) 332-3000 |
NPI Number | 1902247885 |
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Provider Enumeration Date | 07/09/2013 |
Last Update Date | 07/09/2013 |
Medicare PECOS PAC ID | 3678998762 |
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Medicare Enrollment ID | O20200806001716 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902247885 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | 54147 (California) | Primary |
Provider Name | Atef E Hana |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1437219003 PECOS PAC ID: 2163846544 Enrollment ID: I20200717001306 |
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