Healthcare Provider Details

I. General information

NPI: 1598681397
Provider Name (Legal Business Name): ELEVATED SMILES GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 DEL PASO RD STE 142
SACRAMENTO CA
95834-7707
US

IV. Provider business mailing address

1954 DEL PASO RD STE 142
SACRAMENTO CA
95834-7707
US

V. Phone/Fax

Practice location:
  • Phone: 916-992-4537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TINA ALLMAN
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 916-580-8282