NPIMap

Organization Active NPI

Western Dental Service, Inc

  • Dentist
  • Carson, CA
National Provider Identifier
1790201267
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
WESTERN DENTAL SERVICE, INC
Practice address
20700 Avalon Blvd Ste 600
Carson, CA 90746-3701
Phone
(310) 241-6175
Fax
(310) 436-6466
NPI assigned
Aug 16, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Preet Takkar
Title
Chief Operations Officer
Phone
(714) 571-3372

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

20700 Avalon Blvd Ste 600
Carson, CA 90746-3701

Mailing address

530 S Main St
Orange, CA 92868-4525
Phone (714) 480-3000

Other identifiers 1

IdentifierTypeStateIssuer
G90179MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Western Dental Services Inc278 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

20700 Avalon Blvd
Ste 600
Carson, CA 90746
Phone (310) 241-6175

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656547200000",
    "number": "1790201267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 S MAIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684525",
            "telephone_number": "714-480-3000",
            "fax_number": "714-571-6445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20700 AVALON BLVD STE 600",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907463701",
            "telephone_number": "310-241-6175",
            "fax_number": "310-436-6466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN DENTAL SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-16",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A",
        "authorized_official_last_name": "TAKKAR",
        "authorized_official_first_name": "PREET",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "714-571-3372"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G90179",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carson, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.