| The Children's Dental Foundation | |
|
200 Falls Canyon Road Avalon CA 90704 | |
| (310) 510-8287 | |
| Not Available |
| Full Name | The Children's Dental Foundation |
|---|---|
| Speciality | Dentist |
| Location | 200 Falls Canyon Road, Avalon, California |
| Authorized Official Name and Position | John Blake (DENTAL DIRECTOR) |
| Authorized Official Contact | 5629333141 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Children's Dental Foundation 200 Falls Canyon Road Avalon CA 90704 Ph: (310) 510-8287 | The Children's Dental Foundation 200 Falls Canyon Road Avalon CA 90704 Ph: (310) 510-8287 |
| NPI Number | 1710161880 |
|---|---|
| Provider Enumeration Date | 12/24/2007 |
| Last Update Date | 01/16/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710161880 | NPI | - | NPPES |
| G90360-03 | Other | CA | DENTI-CAL STATE PROGRAM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (California) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Secondary |
| 126800000X | Dental Assistant | (* (Not Available)) | Secondary |