1568244648 NPI number — GIVE FOR A SMILE

Table of content: (NPI 1568244648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568244648 NPI number — GIVE FOR A SMILE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GIVE FOR A SMILE
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:
1568244648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10861 ACACIA PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92840-5103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-928-4988
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10861 ACACIA PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92840-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-928-4988
Provider Business Practice Location Address Fax Number:
714-462-6116
Provider Enumeration Date:
10/16/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GALLARDO
Authorized Official First Name:
JULIO
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE EXECUTIVE
Authorized Official Telephone Number:
714-928-9807

Provider Taxonomy Codes

  • Taxonomy code: 171400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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