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Organization
MANAVI DENTAL CORPORATION
Active
Organization
MANAVI DENTAL CORPORATION
Active
Other names
WEST COAST DENTAL & ORTHODONTICS, ADULT & KIDS DENTAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MIGUEL REYES (Q/A CONTRACT & COMPLIANCE MANAGER)
(310) 409-4225
Entity
Organization
Contact information
Practice address
16120 S HIGHLAND AVE STE 300, FONTANA, CA 92336-1228
(310) 820-9933
(310) 820-0408
Mailing address
12121 WILSHIRE BLVD STE 1111, LOS ANGELES, CA 90025-1188
(310) 820-9933
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/29/2023
Last updated
07/05/2023
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