Healthcare Provider Details

I. General information

NPI: 1316803117
Provider Name (Legal Business Name): MANTECA SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/25/2025
Last Update Date: 12/25/2025
Certification Date: 12/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 N GRANT AVE
MANTECA CA
95336-4601
US

IV. Provider business mailing address

132 N GRANT AVE
MANTECA CA
95336-4601
US

V. Phone/Fax

Practice location:
  • Phone: 209-239-5996
  • Fax: 209-239-5996
Mailing address:
  • Phone: 209-239-5996
  • Fax: 209-239-5996

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: KIRANDEEP KAUR
Title or Position: PARTNER
Credential: DDS
Phone: 646-413-5840