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General NPI Number Information
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NPI Number | 1215159389
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Entity Type | Organization
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Legal Business Name | WYNDHAMSMITHA ND KIM, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 23838 VALENCIA BLVD. SUITE #301
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City | VALENCIA
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State | CA
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Zip | 91355
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Country | US
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Telephone | 661-291-1412
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Fax | 661-291-1423
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Provider Business Mailing Address
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Address Line | 28097 SMYTH DRIVE SUITE A & C
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City | VALENCIA
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State | CA
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Zip | 91355
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Country | US
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Telephone | 661-291-1412
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Fax | 661-291-1423
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. DAVID R. WYNDHAMSMITH
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Credential | D.D.S., M.D.
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Telephone | 661-291-1412
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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 | 28413
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License Number State | CA
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