| Western Dental Services, Inc. | |
|
1054 Vine St Los Angeles CA 90038-2745 | |
| (323) 465-9055 | |
| (323) 465-1378 |
| Full Name | Western Dental Services, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1054 Vine St, Los Angeles, 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. 1054 Vine St Los Angeles CA 90038-2745 Ph: (323) 465-9055 |
| NPI Number | 1871655795 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 11/05/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871655795 | NPI | - | NPPES |
| G90179-15 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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