Healthcare Provider Details

I. General information

NPI: 1578941977
Provider Name (Legal Business Name): SMILE WORKS, A DENTAL GROUP OF FARUKHI P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15018 LA MIRADA BLVD
LA MIRADA CA
90638-4743
US

IV. Provider business mailing address

3116 E WOODBINE RD
ORANGE CA
92867-2090
US

V. Phone/Fax

Practice location:
  • Phone: 714-521-6827
  • Fax:
Mailing address:
  • Phone: 949-302-9124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number64017
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number57840
License Number StateCA

VIII. Authorized Official

Name: MOHAMMAD SHIRAZ HAIDER
Title or Position: SECRETARY
Credential: DDS
Phone: 949-302-9124