Healthcare Provider Details

I. General information

NPI: 1407782329
Provider Name (Legal Business Name): THE SMILE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4985 EAGLE ROCK BLVD
LOS ANGELES CA
90041-1921
US

IV. Provider business mailing address

4985 EAGLE ROCK BLVD
LOS ANGELES CA
90041-1921
US

V. Phone/Fax

Practice location:
  • Phone: 818-578-4477
  • Fax: 818-578-4467
Mailing address:
  • Phone: 818-578-4477
  • Fax: 818-578-4467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: PAUL REVEREZA
Title or Position: CFO
Credential:
Phone: 818-254-5967