| Maxwell Dental Corporation | |
|
6828 La Tijera Blvd Los Angeles CA 90045-1905 | |
| (310) 216-0971 | |
| (310) 216-1530 |
| Full Name | Maxwell Dental Corporation |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 6828 La Tijera Blvd, Los Angeles, California |
| Authorized Official Name and Position | Frandsen Dorsey Maxwell (CEO,PRESIDENT,DENTIST) |
| Authorized Official Contact | 3102160971 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maxwell Dental Corporation 6828 La Tijera Blvd Los Angeles CA 90045-1905 Ph: (310) 216-0971 | Maxwell Dental Corporation 6828 La Tijera Blvd Los Angeles CA 90045-1905 Ph: (310) 216-0971 |
| NPI Number | 1538389069 |
|---|---|
| Provider Enumeration Date | 04/26/2007 |
| Last Update Date | 09/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538389069 | NPI | - | NPPES |
| B03594401 | Other | CA | DENTI-CAL |
| 662491 | Other | CA | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 35944 (California) | Primary |
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