| Wilshire Dental Group | |
|
6200 Wilshire Blvd Suite # 1104 Los Angeles CA 90048-5801 | |
| (323) 525-1819 | |
| (323) 525-1883 |
| Full Name | Wilshire Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 6200 Wilshire Blvd, Los Angeles, California |
| Authorized Official Name and Position | Irina Sumenko (PRESIDENT) |
| Authorized Official Contact | 3235251819 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilshire Dental Group 6200 Wilshire Blvd Suite # 1104 Los Angeles CA 90048-5801 Ph: (323) 525-1819 | Wilshire Dental Group 6200 Wilshire Blvd Suite # 1104 Los Angeles CA 90048-5801 Ph: (323) 525-1819 |
| NPI Number | 1457400269 |
|---|---|
| Provider Enumeration Date | 01/10/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9032548409 |
|---|---|
| Medicare Enrollment ID | O20200406002631 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457400269 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 42427 (California) | Primary |
| Provider Name | Irina Sumenko |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1003965112 PECOS PAC ID: 1355651829 Enrollment ID: I20200406002973 |
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