| Western Dental Services, Inc. | |
|
1835 Newport Blvd Ste C138 Costa Mesa CA 92627-5009 | |
| (949) 645-0218 | |
| (949) 645-0487 |
| Full Name | Western Dental Services, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1835 Newport Blvd Ste C138, Costa Mesa, California |
| Authorized Official Name and Position | William Demberecky (EVP & CHIEF STRATEGY AND GROWTH) |
| Authorized Official Contact | 7145713503 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Western Dental Services, Inc. 530 S Main St Orange CA 92868-4525 Ph: (714) 480-3000 | Western Dental Services, Inc. 1835 Newport Blvd Ste C138 Costa Mesa CA 92627-5009 Ph: (949) 645-0218 |
| NPI Number | 1437213931 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 06/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437213931 | NPI | - | NPPES |
| G90179-28 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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