| Western Dental Services, Inc. | |
|
1144 Sonoma Ave Ste 108 Santa Rosa CA 95405-4812 | |
| (707) 523-2399 | |
| (707) 523-1411 |
| Full Name | Western Dental Services, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 1144 Sonoma Ave Ste 108, Santa Rosa, California |
| Authorized Official Name and Position | Preet Takkar (CHIEF INFORMATION OFFICER) |
| Authorized Official Contact | 7145713372 |
| 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. 1144 Sonoma Ave Ste 108 Santa Rosa CA 95405-4812 Ph: (707) 523-2399 |
| NPI Number | 1023582657 |
|---|---|
| Provider Enumeration Date | 01/16/2019 |
| Last Update Date | 03/28/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023582657 | NPI | - | NPPES |
| G90179 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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