| Western Dental Services, Inc. | |
|
21729 Vanowen St Canoga Park CA 91303-2618 | |
| (818) 898-0858 | |
| (818) 493-4309 |
| Full Name | Western Dental Services, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 21729 Vanowen St, Canoga Park, 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 Services, Inc. 530 S Main St Orange CA 92868-4525 Ph: (714) 571-3653 | Western Dental Services, Inc. 21729 Vanowen St Canoga Park CA 91303-2618 Ph: (818) 898-0858 |
| NPI Number | 1114430824 |
|---|---|
| Provider Enumeration Date | 11/16/2017 |
| Last Update Date | 11/16/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114430824 | NPI | - | NPPES |
| G90179 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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