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38745 Tierra Subida Ave Ste 150 Palmdale CA 93551-4567 | |
(661) 272-9091 | |
Not Available |
Full Name | |
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Speciality | Dentist |
Location | 38745 Tierra Subida Ave Ste 150, Palmdale, California |
Authorized Official Name and Position | David Park (CEO) |
Authorized Official Contact | 3104031117 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1669 W Avenue J Ste 305 Lancaster CA 93534-2870 Ph: (661) 802-7544 | 38745 Tierra Subida Ave Ste 150 Palmdale CA 93551-4567 Ph: (661) 272-9091 |
NPI Number | 1790263465 |
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Provider Enumeration Date | 08/03/2018 |
Last Update Date | 08/03/2018 |
Identifier | Type | State | Issuer |
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1790263465 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | 53724 (California) | Primary |