| El Segundo Modern Dentistry | |
|
310 E Grand Ave Ste 102 El Segundo CA 90245-3871 | |
| (424) 277-1138 | |
| Not Available |
| Full Name | El Segundo Modern Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 310 E Grand Ave Ste 102, El Segundo, California |
| Authorized Official Name and Position | Omid R Barkhordar (OWNER) |
| Authorized Official Contact | 4242771138 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| El Segundo Modern Dentistry 310 E Grand Ave Ste 102 El Segundo CA 90245-3871 Ph: (424) 277-1138 | El Segundo Modern Dentistry 310 E Grand Ave Ste 102 El Segundo CA 90245-3871 Ph: (424) 277-1138 |
| NPI Number | 1396260972 |
|---|---|
| Provider Enumeration Date | 08/04/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396260972 | NPI | - | NPPES |
| 1538607965 | Other | CA | NPI |
| 1821229444 | Other | CA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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