Healthcare Provider Details

I. General information

NPI: 1528250412
Provider Name (Legal Business Name): SMILENEEDS DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1183 E FOOTHILL BLVD SUITE150
UPLAND CA
91786-4079
US

IV. Provider business mailing address

1183 E FOOTHILL BLVD SUITE150
UPLAND CA
91786-4079
US

V. Phone/Fax

Practice location:
  • Phone: 909-466-1245
  • Fax: 909-912-8245
Mailing address:
  • Phone: 909-466-1245
  • Fax: 909-912-8245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIANO CASTRO
Title or Position: OWNER
Credential: DDS
Phone: 906-466-1245