Healthcare Provider Details

I. General information

NPI: 1922788330
Provider Name (Legal Business Name): DELTA DENTAL SMILE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

962 LUTHER DR
SPRING VALLEY CA
91977-5262
US

IV. Provider business mailing address

962 LUTHER DR
SPRING VALLEY CA
91977-5262
US

V. Phone/Fax

Practice location:
  • Phone: 971-999-3399
  • Fax:
Mailing address:
  • Phone: 971-999-3399
  • 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: ATUL CHAUHAN SOOD
Title or Position: FOUNDER
Credential:
Phone: 971-999-3399