| |
1021 W Avenue M14 Palmdale CA 93551-1440 | |
(661) 267-4000 | |
(661) 267-4018 |
Full Name | |
---|---|
Speciality | Dentist - General Practice |
Location | 1021 W Avenue M14, Palmdale, California |
Authorized Official Name and Position | Robert Haze (OWNER) |
Authorized Official Contact | 6612674000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1021 W Avenue M14 Palmdale CA 93551-1440 Ph: (661) 267-4000 | 1021 W Avenue M14 Palmdale CA 93551-1440 Ph: (661) 267-4000 |
NPI Number | 1992133318 |
---|---|
Provider Enumeration Date | 10/22/2013 |
Last Update Date | 06/09/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1992133318 | NPI | - | NPPES |
1972629640 | Other | CA | DENTI-CAL |
1992133318 | Other | CA | DENTI-CAL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 35883 (California) | Primary |