| Western Dental Services, Inc. | |
|
1801 Newport Blvd Suite B Costa Mesa CA 92627-2701 | |
| (949) 548-5588 | |
| (949) 548-5731 |
| Full Name | Western Dental Services, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 1801 Newport Blvd, Costa Mesa, California |
| Authorized Official Name and Position | John Luther (CHIEF DENTAL OFFICER) |
| Authorized Official Contact | 7144803000 |
| 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) 480-3000 | Western Dental Services, Inc. 1801 Newport Blvd Suite B Costa Mesa CA 92627-2701 Ph: (949) 548-5588 |
| NPI Number | 1750822490 |
|---|---|
| Provider Enumeration Date | 03/14/2017 |
| Last Update Date | 03/14/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750822490 | NPI | - | NPPES |
| G90179 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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