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General NPI Number Information
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NPI Number | 1073945556
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILES FAMILY DENTAL
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Dates
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Enumeration Date | 08/06/2013
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 150 S GLENDORA AVE
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City | WEST COVINA
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State | CA
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Zip | 91790-3038
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Country | US
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Telephone | 626-919-2322
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Fax |
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Provider Business Mailing Address
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Address Line | 150 S GLENDORA AVE
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City | WEST COVINA
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State | CA
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Zip | 91790-3038
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Country | US
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Telephone | 626-919-2322
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | DR. CORINTHIA MORALES ANDAL
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Credential | DDS
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Telephone | 626-919-2322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 53574
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License Number State | CA
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