Healthcare Provider Details

I. General information

NPI: 1316502123
Provider Name (Legal Business Name): SMILE BRIGHT DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 TENNESSEE ST STE K1
REDLANDS CA
92373-8152
US

IV. Provider business mailing address

3218 E HOLT AVE STE 202
WEST COVINA CA
91791-2310
US

V. Phone/Fax

Practice location:
  • Phone: 909-798-4000
  • Fax:
Mailing address:
  • Phone:
  • 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: FRANCISCO DONAVANIK FORES
Title or Position: CEO
Credential: DDS
Phone: 661-917-0507