Provider Demographics
NPI:1538638796
Name:WEST COAST DENTAL
Entity Type:Organization
Organization Name:WEST COAST DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:BHAVIK
Authorized Official - Middle Name:N
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:323-482-7408
Mailing Address - Street 1:4415 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1407
Mailing Address - Country:US
Mailing Address - Phone:323-482-7408
Mailing Address - Fax:
Practice Address - Street 1:12730 HAWTHORNE BLVD STE D
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3919
Practice Address - Country:US
Practice Address - Phone:310-220-0914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR32431Medicaid