Provider Demographics
NPI:1740392216
Name:THE CHILDREN'S DENTAL CENTER
Entity type:Organization
Organization Name:THE CHILDREN'S DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-419-3000
Mailing Address - Street 1:300 E BUCKTHORN ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-3418
Mailing Address - Country:US
Mailing Address - Phone:310-419-3000
Mailing Address - Fax:310-677-3087
Practice Address - Street 1:300 E BUCKTHORN ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3418
Practice Address - Country:US
Practice Address - Phone:310-419-3000
Practice Address - Fax:310-677-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA199721223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty