| Western Dental Service, Inc | |
|
20700 Avalon Blvd Ste 600 Carson CA 90746-3701 | |
| (310) 241-6175 | |
| (310) 436-6466 |
| Full Name | Western Dental Service, Inc |
|---|---|
| Speciality | Dentist |
| Location | 20700 Avalon Blvd Ste 600, Carson, California |
| Authorized Official Name and Position | Preet Takkar (CHIEF OPERATIONS OFFICER) |
| Authorized Official Contact | 7145713372 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Western Dental Service, Inc 530 S Main St Orange CA 92868-4525 Ph: (714) 480-3000 | Western Dental Service, Inc 20700 Avalon Blvd Ste 600 Carson CA 90746-3701 Ph: (310) 241-6175 |
| NPI Number | 1790201267 |
|---|---|
| Provider Enumeration Date | 08/16/2017 |
| Last Update Date | 06/30/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790201267 | NPI | - | NPPES |
| G90179 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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