| Ucla School Of Dentistry | |
|
323 Lincoln Blvd Venice CA 90291-2842 | |
| (310) 392-4103 | |
| Not Available |
| Full Name | Ucla School Of Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 323 Lincoln Blvd, Venice, California |
| Authorized Official Name and Position | John Yamamoto (DIRECTOR) |
| Authorized Official Contact | 3103924103 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ucla School Of Dentistry 323 Lincoln Blvd Venice CA 90291-2842 Ph: (310) 392-4103 | Ucla School Of Dentistry 323 Lincoln Blvd Venice CA 90291-2842 Ph: (310) 392-4103 |
| NPI Number | 1255465902 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255465902 | NPI | - | NPPES |
| G01004-01 | Other | CA | DENTI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (California) | Primary |
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Ucla Venice Clinical Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 323 Lincoln Blvd, Venice, CA 90291 Phone: 310-392-4103 Fax: 310-392-8513 |