Provider Demographics
NPI:1972842516
Name:WESTERN UNIVERSITY OF HEALTH SCIENCES
Entity Type:Organization
Organization Name:WESTERN UNIVERSITY OF HEALTH SCIENCES
Other - Org Name:WESTERN UNIVERISTY DENTAL CENTER-MACLAREN CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FRIEDRICHSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-706-3504
Mailing Address - Street 1:309 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1854
Mailing Address - Country:US
Mailing Address - Phone:909-706-3943
Mailing Address - Fax:
Practice Address - Street 1:4024 DURFEE AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-2510
Practice Address - Country:US
Practice Address - Phone:909-706-3943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental