| Western Dental Services, Inc. | |
|
4123 University Ave San Diego CA 92105-1418 | |
| (619) 521-0012 | |
| (619) 521-0961 |
| Full Name | Western Dental Services, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4123 University Ave, San Diego, 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. 4123 University Ave San Diego CA 92105-1418 Ph: (619) 521-0012 |
| NPI Number | 1841354347 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841354347 | NPI | - | NPPES |
| G90179-20 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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