| Amerident Health Pro, Inc. | |
|
3130 S Sepulveda Blvd Suite D Los Angeles CA 90034-4215 | |
| (310) 268-0646 | |
| (310) 268-0536 |
| Full Name | Amerident Health Pro, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 3130 S Sepulveda Blvd, Los Angeles, California |
| Authorized Official Name and Position | William Ginzburg (PRACTICE OWNER) |
| Authorized Official Contact | 3102680646 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amerident Health Pro, Inc. 3130 S Sepulveda Blvd Suite D Los Angeles CA 90034-4215 Ph: (310) 268-0646 | Amerident Health Pro, Inc. 3130 S Sepulveda Blvd Suite D Los Angeles CA 90034-4215 Ph: (310) 268-0646 |
| NPI Number | 1467818401 |
|---|---|
| Provider Enumeration Date | 01/06/2016 |
| Last Update Date | 01/06/2016 |
| Medicare PECOS PAC ID | 3779888193 |
|---|---|
| Medicare Enrollment ID | O20160223002147 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467818401 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 40241 (California) | Primary |
| Provider Name | Mohamed I Kayali |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1477612406 PECOS PAC ID: 1850693326 Enrollment ID: I20160322001714 |
| Provider Name | Bill E Ginzburg |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1336360510 PECOS PAC ID: 8224334107 Enrollment ID: I20190528000996 |
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