Healthcare Provider Details

I. General information

NPI: 1790232205
Provider Name (Legal Business Name): ISMILE DENTAL GROUP OF REBECCA S. AHLERS, DDS. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18377 BEACH BLVD STE 328
HUNTINGTON BEACH CA
92648-1350
US

IV. Provider business mailing address

18377 BEACH BLVD STE 328
HUNTINGTON BEACH CA
92648-1350
US

V. Phone/Fax

Practice location:
  • Phone: 714-602-6327
  • Fax:
Mailing address:
  • Phone: 714-602-6327
  • Fax: 714-602-6275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number34569
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA SUSAN AHLERS
Title or Position: OWNER DENTIST/PRESIDENT
Credential: DDS
Phone: 714-602-6327