Provider Demographics
NPI:1780958843
Name:WEST COAST DENTAL GROUP
Entity type:Organization
Organization Name:WEST COAST DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DENTAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CARREON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-318-2013
Mailing Address - Street 1:31419 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:NUEVO
Mailing Address - State:CA
Mailing Address - Zip Code:92567-8956
Mailing Address - Country:US
Mailing Address - Phone:951-318-2013
Mailing Address - Fax:
Practice Address - Street 1:31419 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:NUEVO
Practice Address - State:CA
Practice Address - Zip Code:92567-8956
Practice Address - Country:US
Practice Address - Phone:951-318-2013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76905126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Multi-Specialty