| |
4149 Tweedy Blvd Ste G South Gate CA 90280-6167 | |
(323) 567-3333 | |
(323) 567-2929 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 4149 Tweedy Blvd Ste G, South Gate, California |
Authorized Official Name and Position | Farhad Manavi (OWNER) |
Authorized Official Contact | 3235673333 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4149 Tweedy Blvd Ste G South Gate CA 90280-6167 Ph: (323) 567-3333 | 4149 Tweedy Blvd Ste G South Gate CA 90280-6167 Ph: (323) 567-3333 |
NPI Number | 1962625418 |
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Provider Enumeration Date | 04/11/2007 |
Last Update Date | 06/27/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1962625418 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 38558 (California) | Primary |
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