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General NPI Number Information
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NPI Number | 1255597530
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Entity Type | Organization
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Legal Business Name | AESTHETIC SMILE DENTAL CENTER
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 3203 CARSON ST SUITE # 2
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City | LAKEWOOD
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State | CA
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Zip | 90712-4006
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Country | US
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Telephone | 562-496-1888
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Fax | 562-496-0688
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Provider Business Mailing Address
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Address Line | 3203 CARSON ST SUITE # 2
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City | LAKEWOOD
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State | CA
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Zip | 90712-4006
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Country | US
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Telephone | 562-496-1888
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Fax | 562-496-0688
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. MARILOU S. TOQUERO
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Credential | DDS
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Telephone | 562-496-1888
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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 | 54432
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License Number State | CA
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