1205054848 NPI number — THE SMILE FACTORY FOR THE CHILDREN OF THE DESERT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205054848 NPI number — THE SMILE FACTORY FOR THE CHILDREN OF THE DESERT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SMILE FACTORY FOR THE CHILDREN OF THE DESERT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205054848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 S. SUNRISE WAY, A-409
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92262-6778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-318-2465
Provider Business Mailing Address Fax Number:
760-406-6155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 N. INDIAN CANYON DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-318-2465
Provider Business Practice Location Address Fax Number:
760-406-6155
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FRENCH
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DENTAL DIRECTOR
Authorized Official Telephone Number:
760-318-2465

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  17680 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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