Provider Demographics
NPI:1275029969
Name:DR. WON'S DDS DENTAL, INC.
Entity Type:Organization
Organization Name:DR. WON'S DDS DENTAL, INC.
Other - Org Name:PACIFIC DENTAL CARE/DENTAL GROUP OF DR. WON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-267-5700
Mailing Address - Street 1:2535 W ROSAMOND BLVD # B
Mailing Address - Street 2:
Mailing Address - City:ROSAMOND
Mailing Address - State:CA
Mailing Address - Zip Code:93560-6266
Mailing Address - Country:US
Mailing Address - Phone:661-256-2500
Mailing Address - Fax:
Practice Address - Street 1:2535 W ROSAMOND BLVD # B
Practice Address - Street 2:
Practice Address - City:ROSAMOND
Practice Address - State:CA
Practice Address - Zip Code:93560-9356
Practice Address - Country:US
Practice Address - Phone:661-256-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty