Healthcare Provider Details

I. General information

NPI: 1841156718
Provider Name (Legal Business Name): FULLER SMILES IRVINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 SAND CANYON AVE STE 300
IRVINE CA
92618-3718
US

IV. Provider business mailing address

16100 SAND CANYON AVE STE 300
IRVINE CA
92618-3718
US

V. Phone/Fax

Practice location:
  • Phone: 909-456-5089
  • Fax:
Mailing address:
  • Phone: 909-456-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARSH AHUJA
Title or Position: CEO
Credential:
Phone: 909-456-5089