Healthcare Provider Details

I. General information

NPI: 1649016122
Provider Name (Legal Business Name): TWIN SMILES ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 ALMA ST
PALO ALTO CA
94306-3501
US

IV. Provider business mailing address

3301 ALMA ST
PALO ALTO CA
94306-3501
US

V. Phone/Fax

Practice location:
  • Phone: 650-331-1171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AMELIA STOKER
Title or Position: ORTHODONTIST
Credential:
Phone: 801-560-3702