Healthcare Provider Details

I. General information

NPI: 1407040108
Provider Name (Legal Business Name): U SMILE FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 BOWLING DR STE 210
SACRAMENTO CA
95823-2043
US

IV. Provider business mailing address

7171 BOWLING DR STE 210
SACRAMENTO CA
95823-2043
US

V. Phone/Fax

Practice location:
  • Phone: 916-428-0114
  • Fax: 916-428-8502
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number53996
License Number StateCA

VIII. Authorized Official

Name: POGE HER
Title or Position: DENTIST/OWNER
Credential: D.D.S
Phone: 916-428-0114