Provider Demographics
NPI:1720586324
Name:COMBS, DAVID (DENTAL HYGIENE)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:COMBS
Suffix:
Gender:M
Credentials:DENTAL HYGIENE
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DENTAL HYGIENE
Mailing Address - Street 1:WEST COAST DENTAL SERVICES, INC. 12121 WILSHIRE BLVD.,S
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WEST COAST DENTAL SERVICES, INC. 12121 WILSHIRE BLVD.,
Practice Address - Street 2:
Practice Address - City:LOSANGELES
Practice Address - State:WA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:206-739-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH605509881223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty