Healthcare Provider Details

I. General information

NPI: 1699147561
Provider Name (Legal Business Name): SVETLANA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28237 NEWHALL RANCH RD
VALENCIA CA
91355-0986
US

IV. Provider business mailing address

17334 CANVAS ST
SANTA CLARITA CA
91387-3164
US

V. Phone/Fax

Practice location:
  • Phone: 661-257-4242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number75684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: