Healthcare Provider Details

I. General information

NPI: 1407285729
Provider Name (Legal Business Name): DR. SMAILI 'SMILEY' DENTAL GROUP OF CALIFORNIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 WILSHIRE BLVD SUITE 411
BEVERLY HILLS CA
90211-1831
US

IV. Provider business mailing address

9025 WILSHIRE BLVD SUITE 411
BEVERLY HILLS CA
90211-1831
US

V. Phone/Fax

Practice location:
  • Phone: 310-432-4202
  • Fax: 310-855-5010
Mailing address:
  • Phone: 310-432-4202
  • Fax: 310-855-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number59418
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number59418
License Number StateCA

VIII. Authorized Official

Name: DR. TARICK KAMAL SMAILI
Title or Position: OWNER
Credential: MD
Phone: 310-490-6145