Organization
WEST COAST DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SHAUN CREDILLE RDA (REGISTERED DENTAL ASSISTANT)
(559) 325-6161
Entity
Organization
Contact information
Practice address
1330 SHAW AVE STE 103, CLOVIS, CA 93612-3985
(559) 325-6161
Mailing address
1330 SHAW AVE STE 103, CLOVIS, CA 93612-3985
(559) 325-6161
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
75261
CA
Other
Enumeration date
04/14/2011
Last updated
04/14/2011
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