| Western Dental Service, Inc | |
|
2094 E Highland Ave San Bernardino CA 92404-4626 | |
| (909) 388-2420 | |
| (909) 388-2426 |
| Full Name | Western Dental Service, Inc |
|---|---|
| Speciality | Dentist |
| Location | 2094 E Highland Ave, San Bernardino, California |
| Authorized Official Name and Position | Maribel Zamora (ENROLLMENT COORDINATOR) |
| Authorized Official Contact | 7145713104 |
| 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 2094 E Highland Ave San Bernardino CA 92404-4626 Ph: (909) 388-2420 |
| NPI Number | 1922406883 |
|---|---|
| Provider Enumeration Date | 12/09/2014 |
| Last Update Date | 12/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922406883 | NPI | - | NPPES |
| G90179 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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