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General NPI Number Information
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NPI Number | 1023290822
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Entity Type | Organization
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Legal Business Name | THE SMILE FACTORY OF THE TIEMPO DE LOS NINOS
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 1140 N INDIAN CANYON DR
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City | PALM SPRINGS
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State | CA
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Zip | 92262-4872
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Country | US
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Telephone | 760-318-2465
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Fax |
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Provider Business Mailing Address
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Address Line | 100 S SUNRISE WAY A-409
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City | PALM SPRINGS
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State | CA
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Zip | 92262-6778
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Country | US
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Telephone | 760-318-2465
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Fax | 760-406-6155
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHARON KAY STEVENS
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Credential |
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Telephone | 760-318-2465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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