Organization
STEVEN GEDULD DDS DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE L TILUS (OFFICE MANAGER)
(760) 361-8056
Entity
Organization
Contact information
Practice address
73660 CIVIC CENTER DR STE B, TWENTYNINE PALMS, CA 92277-2582
(760) 361-8056
(760) 361-8058
Mailing address
73660 CIVIC CENTER DR STE B, TWENTYNINE PALMS, CA 92277-2582
(760) 361-8056
(760) 361-8058
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
032959
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
844119
UNITED CONCORDIA
CA
Enumeration date
02/15/2007
Last updated
08/22/2020
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