Organization
WESTSIDE PEDIATRIC DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMMANUEL BERNARD GROSS DDS (OWNER)
(310) 451-5748
Entity
Organization
Contact information
Practice address
1304 15TH ST STE 206, SANTA MONICA, CA 90404-1811
(310) 451-5748
(310) 393-9528
Mailing address
1304 15TH ST STE 206, SANTA MONICA, CA 90404-1811
(310) 451-5748
(310) 393-9528
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
39266
CA
1223P0221X
Pediatric Dentistry
59919
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
31742
CA
Other
Enumeration date
08/25/2015
Last updated
08/25/2015
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