Organization
WESTCOAST DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIGUEL REYES (CREDENTIALING)
(310) 820-9933
Entity
Organization
Contact information
Practice address
12730 HAWTHORNE BLVD STE D, HAWTHORNE, CA 90250-3919
(310) 644-4000
Mailing address
12121 WILSHIRE BLVD STE 1111, LOS ANGELES, CA 90025-1188
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
25300
CA
Other
Enumeration date
06/11/2013
Last updated
06/11/2013
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