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Organization
WALTER JEFFERSON DENTAL CORPORATION
Active
Organization
WALTER JEFFERSON DENTAL CORPORATION
Active
Other names
Harbor City Modern Dentistry Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER JEFFERSON DDS (OWNER)
(310) 539-3245
Entity
Organization
Contact information
Practice address
962 SEPULVEDA BLVD, HARBOR CITY, CA 90710-1405
(310) 539-3245
Mailing address
17000 RED HILL AVE, IRVINE, CA 92614-5626
(714) 845-8890
(303) 952-0892
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/25/2019
Last updated
09/25/2019
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