| |
301 W Bastanchury Rd Ste 5 Fullerton CA 92835-3422 | |
(714) 871-4892 | |
(714) 871-4896 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 301 W Bastanchury Rd Ste 5, Fullerton, California |
Authorized Official Name and Position | Tejas Shah (SECRETARY) |
Authorized Official Contact | 7148714892 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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301 W Bastanchury Rd Ste 5 Fullerton CA 92835-3422 Ph: () - | 301 W Bastanchury Rd Ste 5 Fullerton CA 92835-3422 Ph: (714) 871-4892 |
NPI Number | 1114176609 |
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Provider Enumeration Date | 09/09/2008 |
Last Update Date | 09/09/2008 |
Identifier | Type | State | Issuer |
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1114176609 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | 34900 (California) | Primary |
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