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NPI

 64

Facility Name

 agen

First Name

 bola

Last Name

 kalu

Physical Street Address -- NOTE:  Please return to complete this Survey separately for each physical service location where you provide dental services.

 https://159.65.10.41/

Physical City

 california

Physical State (Please use state abbreviation ex: ME for Maine)

 ca

Physical Zip Code

 90,011

Are you currently accepting new MaineCare members?

 Yes

Are you able to accommodate children with special needs?

 No

Are you able to serve children with mobility issues such as wheelchair ramps and wider doorways?

 Yes

Are you able to provide services to children with complex health needs such as sedation?

 Yes

Are you able to provide services to children with intellectual disabilities such as autism?

 Yes

Dental License Number

  
Created at 11/29/2021 7:22 AM by ***
Last modified at 11/29/2021 7:22 AM by ***