Healthcare Provider Details

I. General information

NPI: 1801720057
Provider Name (Legal Business Name): SMILE TO LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 W CALIFORNIA AVE APT D
GLENDALE CA
91203-2874
US

IV. Provider business mailing address

641 W CALIFORNIA AVE APT D
GLENDALE CA
91203-2874
US

V. Phone/Fax

Practice location:
  • Phone: 747-474-2777
  • Fax:
Mailing address:
  • Phone: 747-474-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MGER KHEBIANTS
Title or Position: OWNER
Credential:
Phone: 747-474-2777