Healthcare Provider Details

I. General information

NPI: 1679972525
Provider Name (Legal Business Name): GIVING SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2014
Last Update Date: 08/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 FAIR OAKS BLVD #120
SACRAMENTO CA
95825-7663
US

IV. Provider business mailing address

2410 FAIR OAKS BLVD #120
SACRAMENTO CA
95825-7663
US

V. Phone/Fax

Practice location:
  • Phone: 916-934-8527
  • Fax:
Mailing address:
  • Phone: 916-934-8527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number06332
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberL11402552
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38494
License Number StateCA

VIII. Authorized Official

Name: JOHN BERTSCH
Title or Position: PRESIDENT
Credential: DENTIST
Phone: 916-934-8527