Healthcare Provider Details

I. General information

NPI: 1124321138
Provider Name (Legal Business Name): UNLIMITED SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 N MAIN ST SUITE 1060-A
WALNUT CREEK CA
94596-3722
US

IV. Provider business mailing address

2033 N MAIN ST SUITE 1060-A
WALNUT CREEK CA
94596-3722
US

V. Phone/Fax

Practice location:
  • Phone: 925-300-3992
  • Fax: 925-952-7376
Mailing address:
  • Phone: 925-300-3992
  • Fax: 925-952-7376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. BLANCA CASILLAS
Title or Position: VICE PRESIDENT
Credential:
Phone: 925-300-3992