|
| |
|
44841 N 10th St W Lancaster CA 93534 | |
| (661) 948-1655 | |
| (661) 940-9636 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 44841 N 10th St W, Lancaster, California |
| Authorized Official Name and Position | Soo Tae Park (OWNER PRESIDENT) |
| Authorized Official Contact | 6619481655 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
44841 N 10th St W Lancaster CA 93534 Ph: (661) 948-1655 | 44841 N 10th St W Lancaster CA 93534 Ph: (661) 948-1655 |
| NPI Number | 1679538037 |
|---|---|
| Provider Enumeration Date | 04/19/2006 |
| Last Update Date | 10/09/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679538037 | NPI | - | NPPES |
| G9225701 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 33967 (California) | Primary |
| 122300000X | Dentist | 22315 (California) | Secondary |
| 122300000X | Dentist | 16496 (California) | Secondary |
Romeo I. Stoll, Dds, Ms Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1340 W Avenue J, Lancaster, CA 93534 Phone: 661-948-4674 | |
Western Dental Services, Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 44407 Challenger Way, Lancaster, CA 93535 Phone: 661-341-3100 Fax: 661-942-2305 | |
Bilal Shammout Dds Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 44215 15th St W Ste 313, Lancaster, CA 93534 Phone: 661-948-2721 Fax: 661-948-4055 | |
Bradford Boyd, Dds, Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 151 E Avenue J, Lancaster, CA 93535 Phone: 661-942-1179 |