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Organization
SAN PEDRO DENTAL
Active
Organization
SAN PEDRO DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SPEED FRY (MANAGER)
(310) 832-5361
Entity
Organization
Contact information
Practice address
520 W 7TH ST, SAN PEDRO, CA 90731-3116
(310) 832-5361
(310) 831-8836
Mailing address
520 W 7TH ST, SAN PEDRO, CA 90731-3116
(310) 832-5361
(310) 831-8836
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
20546
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B20546-03
DENTICAL
CA
Enumeration date
05/12/2011
Last updated
05/12/2011
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