Provider Demographics
NPI:1982002002
Name:WPD DENTAL GROUP
Entity type:Organization
Organization Name:WPD DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-380-7900
Mailing Address - Street 1:3700 WILSHIRE BLVD STE 780
Mailing Address - Street 2:STE780
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3001
Mailing Address - Country:US
Mailing Address - Phone:213-380-7900
Mailing Address - Fax:
Practice Address - Street 1:3700 WILSHIRE BLVD STE 780
Practice Address - Street 2:STE780
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3001
Practice Address - Country:US
Practice Address - Phone:213-380-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAN MS DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-06
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304161223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty