1528250412 NPI number — SMILENEEDS DENTAL

Table of content: (NPI 1528250412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528250412 NPI number — SMILENEEDS DENTAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMILENEEDS DENTAL
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:
1528250412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1183 E FOOTHILL BLVD
Provider Second Line Business Mailing Address:
SUITE150
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-4079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-466-1245
Provider Business Mailing Address Fax Number:
909-912-8245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1183 E FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
SUITE150
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91786-4079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-466-1245
Provider Business Practice Location Address Fax Number:
909-912-8245
Provider Enumeration Date:
08/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASTRO
Authorized Official First Name:
MARIANO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
906-466-1245

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D43911-01 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com