| Westport Dental | |
|
420 S State College Blvd Anaheim CA 92806-4119 | |
| (909) 973-4086 | |
| Not Available |
| Full Name | Westport Dental |
|---|---|
| Speciality | Clinic/Center |
| Location | 420 S State College Blvd, Anaheim, California |
| Authorized Official Name and Position | Donna Jeanette Woo (DENTIST BUSINESS OWNER) |
| Authorized Official Contact | 7147720770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Westport Dental 420 S State College Blvd Anaheim CA 92806-4119 Ph: (714) 772-0770 | Westport Dental 420 S State College Blvd Anaheim CA 92806-4119 Ph: (909) 973-4086 |
| NPI Number | 1811194152 |
|---|---|
| Provider Enumeration Date | 06/29/2007 |
| Last Update Date | 03/11/2021 |
| Medicare PECOS PAC ID | 4183023831 |
|---|---|
| Medicare Enrollment ID | O20210528001261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811194152 | NPI | - | NPPES |
| G92495-01 | Other | CA | DENTI-CAL |
| 764870 | Other | CA | UNITED CONCORDIA PROV. # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Donna Jeanette Woo |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1942229273 PECOS PAC ID: 5092114744 Enrollment ID: I20210528001332 |
| Provider Name | Irene Awad |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1053647198 PECOS PAC ID: 5698082345 Enrollment ID: I20210712002688 |
| Provider Name | Kevin Y Liang |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1447802368 PECOS PAC ID: 5890192389 Enrollment ID: I20210927001310 |
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