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Organization
WESTERN DENTAL SERVICE, INC
Active
Organization
WESTERN DENTAL SERVICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIBEL ZAMORA (ENROLLMENT COORDINATOR)
(714) 571-3104
Entity
Organization
Contact information
Practice address
2094 E HIGHLAND AVE, SAN BERNARDINO, CA 92404-4626
(909) 388-2420
(909) 388-2426
Mailing address
530 S MAIN ST, ORANGE, CA 92868-4525
(714) 480-3000
(714) 571-6445
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G90179
—
CA
Enumeration date
12/09/2014
Last updated
12/09/2014
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