| Western Dental Services, Inc. | |
|
12649 Poway Rd Poway CA 92064-4415 | |
| (858) 486-6100 | |
| (858) 486-4564 |
| Full Name | Western Dental Services, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12649 Poway Rd, Poway, California |
| Authorized Official Name and Position | Marina King (PPO COORDINATOR) |
| 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. 12649 Poway Rd Poway CA 92064-4415 Ph: (858) 486-6100 |
| NPI Number | 1992858062 |
|---|---|
| Provider Enumeration Date | 01/19/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992858062 | NPI | - | NPPES |
| G90179-83 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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