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General NPI Number Information
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NPI Number | 1336809870
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL SMILE STUDIO
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Dates
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Enumeration Date | 12/24/2021
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Last Update Date | 12/24/2021
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Provider Practice Location Address
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Address Line | 1732 PROFESSIONAL DR
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City | SACRAMENTO
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State | CA
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Zip | 95825-2105
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Country | US
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Telephone | 916-333-5903
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Fax |
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Provider Business Mailing Address
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Address Line | 1732 PROFESSIONAL DR
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City | SACRAMENTO
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State | CA
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Zip | 95825-2105
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Country | US
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Telephone | 916-333-5903
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KHATEREH N/A TOLOOEI
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Credential | DDS
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Telephone | 916-897-6469
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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 |
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License Number State |
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