Healthcare Provider Details

I. General information

NPI: 1750801197
Provider Name (Legal Business Name): ONE SMILE DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15075 LOS GATOS BLVD STE 100
LOS GATOS CA
95032-2049
US

IV. Provider business mailing address

15075 LOS GATOS BLVD STE 100
LOS GATOS CA
95032-2049
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-2049
  • Fax:
Mailing address:
  • Phone: 408-356-2049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: SOFIA ZANORANO
Title or Position: OFFICE MANAGER
Credential:
Phone: 408-884-8155