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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
MRS. MARIBEL ZAMORA (ENROLLMENT COORDINATOR)
(714) 571-3104
Entity
Organization
Contact information
Practice address
1054 VINE ST, LOS ANGELES, CA 90038-2745
(323) 465-9055
(323) 465-1378
Mailing address
530 S MAIN ST, ORANGE, CA 92868-4525
(714) 480-3000
(714) 571-3560
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G90179-15
—
CA
Enumeration date
12/15/2006
Last updated
11/05/2018
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