Organization
AMERICAN DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SERGE A PRESCOTT DDS (DENTIST)
(626) 337-7271
Entity
Organization
Contact information
Practice address
436 N SUNSET AVE, WEST COVINA, CA 91790-1652
(626) 337-7271
(626) 337-8125
Mailing address
436 N SUNSET AVE, WEST COVINA, CA 91790-1652
(626) 337-7271
(626) 337-8125
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
35537
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
14915
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
25306
CA
124Q00000X
Dental Hygienist
RDH16115
CA
Other
Enumeration date
06/06/2008
Last updated
08/18/2009
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