Healthcare Provider Details

I. General information

NPI: 1104442995
Provider Name (Legal Business Name): DELIVERING SMILES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W RIVERRIDGE AVE
FRESNO CA
93711-6958
US

IV. Provider business mailing address

PO BOX 27011
FRESNO CA
93729-7011
US

V. Phone/Fax

Practice location:
  • Phone: 559-960-2232
  • Fax: 559-431-4349
Mailing address:
  • Phone: 559-960-2232
  • Fax: 559-431-4349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code125K00000X
TaxonomyAdvanced Practice Dental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: MRS. RHODA GONZALES
Title or Position: OWNER
Credential:
Phone: 559-960-2232