Healthcare Provider Details

I. General information

NPI: 1740909506
Provider Name (Legal Business Name): SMILEGIVERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 GANAHL ST RM 25A
LOS ANGELES CA
90033-2019
US

IV. Provider business mailing address

5805 WHITE OAK AVE # 16714
ENCINO CA
91316-1150
US

V. Phone/Fax

Practice location:
  • Phone: 323-269-0415
  • Fax:
Mailing address:
  • Phone: 818-430-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SHMUEL SAMOHA
Title or Position: OWNER
Credential: DDS
Phone: 818-430-9207