| Western Dental Services, Inc. | |
|
1453 N Azusa Ave Ste F-4 Covina CA 91722-1201 | |
| (626) 330-2894 | |
| (626) 333-5886 |
| Full Name | Western Dental Services, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 1453 N Azusa Ave Ste F-4, Covina, 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) 480-3000 | Western Dental Services, Inc. 1453 N Azusa Ave Ste F-4 Covina CA 91722-1201 Ph: (626) 330-2894 |
| NPI Number | 1083128870 |
|---|---|
| Provider Enumeration Date | 12/01/2017 |
| Last Update Date | 12/01/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083128870 | NPI | - | NPPES |
| G90179 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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