Healthcare Provider Details

I. General information

NPI: 1114011020
Provider Name (Legal Business Name): ALL SMILE DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4653 CARMEL MOUNTAIN RD STE. 306
SAN DIEGO CA
92130-6650
US

IV. Provider business mailing address

4653 CARMEL MOUNTAIN RD STE. 306
SAN DIEGO CA
92130-6650
US

V. Phone/Fax

Practice location:
  • Phone: 858-350-0045
  • Fax: 858-228-4367
Mailing address:
  • Phone: 858-350-0045
  • Fax: 858-228-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43914
License Number StateCA

VIII. Authorized Official

Name: DR. CHRISTY CHEN
Title or Position: OWNER
Credential:
Phone: 858-350-0045