Organization
WESTERN DENTAL SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PREET TAKKAR (CHIEF INFORMATION OFFICER)
(714) 571-3372
Entity
Organization
Contact information
Practice address
4242 BEVERLY BLVD, LOS ANGELES, CA 90004-4430
(714) 480-3000
Mailing address
530 S MAIN ST, ORANGE, CA 92868-4525
(714) 480-3000
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G92150-49
—
CA
Enumeration date
04/08/2011
Last updated
02/04/2021
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