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General NPI Number Information
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NPI Number | 1043459365
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Entity Type | Organization
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Legal Business Name | SMILE TIME INC.
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Dates
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Enumeration Date | 02/10/2009
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Last Update Date | 02/10/2009
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Provider Practice Location Address
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Address Line | 11005 FIRESTONE BLVD SUITE 106
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City | NORWALK
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State | CA
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Zip | 90650-2224
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Country | US
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Telephone | 310-766-1975
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Fax | 310-559-6135
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Provider Business Mailing Address
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Address Line | 1835 S LA CIENEGA BLVD SUITE 200
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City | LOS ANGELES
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State | CA
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Zip | 90035-4600
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Country | US
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Telephone | 310-766-1975
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Fax | 310-559-6135
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAMIN RAVAEI
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Credential | DMD
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Telephone | 310-766-1975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 41988
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License Number State | CA
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