Healthcare Provider Details

I. General information

NPI: 1073349932
Provider Name (Legal Business Name): SONRISAS DENTAL HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 MARCO POLO WAY SUITE 4
SAN MATEO CA
94010
US

IV. Provider business mailing address

430 N EL CAMINO REAL
SAN MATEO CA
94401-3710
US

V. Phone/Fax

Practice location:
  • Phone: 650-727-3480
  • Fax: 650-727-3519
Mailing address:
  • Phone: 650-727-3480
  • Fax: 650-727-3519

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: TRACEY CARRILLO FECHER
Title or Position: CEO
Credential:
Phone: 650-727-3484