Healthcare Provider Details

I. General information

NPI: 1437634532
Provider Name (Legal Business Name): VALLE SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 W GRANT LINE RD
TRACY CA
95304-7901
US

IV. Provider business mailing address

3075 BEACON BLVD
WEST SACRAMENTO CA
95691-3462
US

V. Phone/Fax

Practice location:
  • Phone: 209-830-7797
  • Fax: 916-384-3844
Mailing address:
  • Phone: 916-702-1213
  • Fax: 916-384-3844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. YAN KALIKA
Title or Position: OWNER
Credential: DDS
Phone: 916-702-1213