Provider Demographics
NPI:1346603487
Name:B.G. BEDFORD,D.D.S.
Entity Type:Organization
Organization Name:B.G. BEDFORD,D.D.S.
Other - Org Name:BILLY G. BEDFORD, D.D.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTISTRY SINGLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-671-6191
Mailing Address - Street 1:808 E MANCHESTER BLVD
Mailing Address - Street 2:P.O. BOX 1786
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1914
Mailing Address - Country:US
Mailing Address - Phone:310-671-6191
Mailing Address - Fax:310-338-1249
Practice Address - Street 1:808 E MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1914
Practice Address - Country:US
Practice Address - Phone:310-671-6191
Practice Address - Fax:310-338-1249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B.G. BEDFORD, D.D.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27955305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherGENERAL DENTISTRY