| Menifee Lakes Dental Group | |
|
29121 Newport Road, Ste 1 Menifee CA 92584 | |
| (951) 228-9296 | |
| (951) 905-1264 |
| Full Name | Menifee Lakes Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 29121 Newport Road, Ste 1, Menifee, California |
| Authorized Official Name and Position | Poulsen D Kyle (OWNER) |
| Authorized Official Contact | 9512289296 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Menifee Lakes Dental Group Po Box 920050 Dallas TX 75392-0050 Ph: (714) 845-8500 | Menifee Lakes Dental Group 29121 Newport Road, Ste 1 Menifee CA 92584 Ph: (951) 228-9296 |
| NPI Number | 1558884239 |
|---|---|
| Provider Enumeration Date | 07/25/2017 |
| Last Update Date | 03/08/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558884239 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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