Basic Information
| Provider Information | |||||||||
| NPI: | 1841438025 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIVERSAL CARE DENTAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2839 N EASTERN AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900322701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239871020 | ||||||||
| FaxNumber: | 3239871022 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 E HILL ST | ||||||||
| Address2: | |||||||||
| City: | SIGNAL HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907553612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629815816 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2009 | ||||||||
| LastUpdateDate: | 01/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | DIANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DENTAL PROVIDER RELATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5629815816 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 48503 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.