Organization
CHILDRENS DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PERCY MILLS (MANAGER)
(310) 672-7822
Entity
Organization
Contact information
Practice address
345 E MANCHESTER BLVD, INGLEWOOD, CA 90301-1814
(310) 672-7822
(310) 330-3722
Mailing address
345 E MANCHESTER BLVD, INGLEWOOD, CA 90301-1814
(310) 672-7822
(310) 330-0722
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
29015
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D29015
—
CA
Enumeration date
03/18/2013
Last updated
03/18/2013
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