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Organization
WESTERN DENTAL SERVICES, INC.
Active
Organization
WESTERN DENTAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CINDY E AVALOS (PPOCOORDINATOR)
(714) 480-3000
Entity
Organization
Contact information
Practice address
9765 SIERRA AVE STE A, FONTANA, CA 92335-6777
(909) 427-8000
(909) 427-8719
Mailing address
9765 SIERRA AVE STE A, FONTANA, CA 92335-6777
(909) 427-8000
(909) 427-8719
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G90179-73
—
CA
Enumeration date
01/26/2007
Last updated
08/22/2020
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