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Organization
PAKRAVAN DENTAL CORPORATION
Active
Organization
PAKRAVAN DENTAL CORPORATION
Active
Other names
West Coast Dental group of Norco
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
2440 RIVER ROAD, SUITE 140, NORCO, CA 92860
(310) 820-9933
(310) 820-0408
Mailing address
12121 WILSHIRE BLVD STE 1111, LOS ANGELES, CA 90025-1188
(310) 820-9933
(310) 820-0408
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
39862
CA
Other
Enumeration date
11/07/2017
Last updated
11/07/2017
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