| Western Dental Service, Inc | |
| 
					2700 Colorado Blvd Ste 263 Eagle Rock CA 90041-1048  | |
| (323) 987-2175 | |
| (714) 571-6445 | 
| Full Name | Western Dental Service, Inc | 
|---|---|
| Speciality | Dentist | 
| Location | 2700 Colorado Blvd Ste 263, Eagle Rock, California | 
| Authorized Official Name and Position | Preet Takkar (CHIEF OPERATIONS OFFICER) | 
| Authorized Official Contact | 7145713372 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Western Dental Service, Inc 530 S Main St Orange CA 92868-4525 Ph: (714) 480-3000  | Western Dental Service, Inc 2700 Colorado Blvd Ste 263 Eagle Rock CA 90041-1048 Ph: (323) 987-2175  | 
| NPI Number | 1881110351 | 
|---|---|
| Provider Enumeration Date | 08/16/2017 | 
| Last Update Date | 06/30/2022 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1881110351 | NPI | - | NPPES | 
| G90179 | Medicaid | CA | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |