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Organization
THE CHILDREN'S DENTAL FOUNDATION
Active
Organization
THE CHILDREN'S DENTAL FOUNDATION
Active
Parent organization
CHILDREN'S DENTAL HEALTH CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN'S DENTAL HEALTH CLINIC
Authorized official
DR. JOHN BLAKE DDS (DENTAL DIRECTOR)
(562) 933-3141
Entity
Organization
Contact information
Practice address
200 FALLS CANYON ROAD, AVALON, CA 90704
(310) 510-8287
Mailing address
200 FALLS CANYON ROAD, AVALON, CA 90704
(310) 510-8287
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
CA
1223P0221X
Pediatric Dentistry
—
—
126800000X
Dental Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G90360-03
DENTI-CAL STATE PROGRAM
CA
Enumeration date
12/24/2007
Last updated
01/16/2009
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