Farwest Dental Group
Dentist in Wilmington, CA. Organization (NPI-2).
NPI number1699200220
StatusActive
Last updated in NPPESApr 20, 2017
Details
- NPI
- 1699200220
- Entity type
- Organization (NPI-2)
- Legal business name
- Farwest Dental Group
- Organization subpart
- No
- Enumeration date
- Apr 20, 2017
- Last updated
- Apr 20, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 52604 | CA | Yes |
Practice location
1704 N Avalon BlvdWilmington, CA 90744-1433
Phone 310-835-5130 · Fax 310-835-6090
Mailing address
1704 N Avalon BlvdWilmington, CA 90744-1433
Phone 310-835-5130 · Fax 310-835-6090
Authorized official
Hassan Fayoumi
Onwer
3106991549
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