The Children'S Dental Foundation
Organization Active NPI Dentist · Avalon, CA
NPI 1710161880 · NPPES record last updated Jan 16, 2009
Key facts
- NPI
- 1710161880
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- Legal business name
- THE CHILDREN'S DENTAL FOUNDATION
- Practice address
- 200 Falls Canyon Road
Avalon, CA 90704 - Phone
- (310) 510-8287
- NPI assigned
- Dec 24, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- CHILDREN'S DENTAL HEALTH CLINIC
Authorized official
- Name
- Dr. John Blake, DDS
- Title
- Dental Director
- Phone
- (562) 933-3141
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- Children'S Dental Foundation
- Part of
- Children'S Dental Foundation
Locations
200 Falls Canyon Rd
Avalon, CA 90704
Phone (310) 510-8287
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | CA | Yes | |
| Pediatric Dentistry |
1223P0221X | |||
| Dental Assistant |
126800000X |
Addresses
Primary practice location
200 Falls Canyon Road
Avalon, CA 90704
Mailing address
200 Falls Canyon Road
Avalon, CA 90704
Phone (310) 510-8287
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G90360-03 | Other | CA | DENTI-CAL STATE PROGRAM |
Other providers in Avalon, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.