Healthcare Provider Details

I. General information

NPI: 1720292949
Provider Name (Legal Business Name): HEALTHY SMILES FOR KIDS OF ORANGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10602 CHAPMAN AVE SUITE 200
GARDEN GROVE CA
92840-3103
US

IV. Provider business mailing address

10602 CHAPMAN AVE SUITE 200
GARDEN GROVE CA
92840-3103
US

V. Phone/Fax

Practice location:
  • Phone: 714-537-0700
  • Fax: 714-537-0733
Mailing address:
  • Phone: 714-537-0700
  • Fax: 714-537-0733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number550000106
License Number StateCA

VIII. Authorized Official

Name: MRS. ELIZABETH A BEAR
Title or Position: CEO
Credential: RN, JD
Phone: 714-537-0700