| State Dental Inc. | |
|
3175 Firestone Blvd Ste 200 South Gate CA 90280-2951 | |
| (323) 563-9124 | |
| (323) 563-9814 |
| Full Name | State Dental Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3175 Firestone Blvd Ste 200, South Gate, California |
| Authorized Official Name and Position | Larissa Gushansky (OWNER) |
| Authorized Official Contact | 3235639124 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Dental Inc. 3175 Firestone Blvd Ste 200 South Gate CA 90280-2951 Ph: (323) 563-9124 | State Dental Inc. 3175 Firestone Blvd Ste 200 South Gate CA 90280-2951 Ph: (323) 563-9124 |
| NPI Number | 1154516680 |
|---|---|
| Provider Enumeration Date | 09/07/2007 |
| Last Update Date | 11/30/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154516680 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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