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General NPI Number Information
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NPI Number | 1386208197
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Entity Type | Organization
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Legal Business Name | BRITE SMILES OF CALIFORNIA
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Dates
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Enumeration Date | 04/26/2019
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 152 VIA SAN NICOLO
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City | PALM DESERT
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State | CA
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Zip | 92260-1803
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Country | US
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Telephone | 760-625-3708
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Fax |
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Provider Business Mailing Address
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Address Line | 152 VIA SAN NICOLO
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City | PALM DESERT
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State | CA
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Zip | 92260-1803
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Country | US
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Telephone | 760-625-3708
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Fax |
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Authorized Official
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Title or Position | MOBILE DENTAL HYGIENIST
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Name | BETTY ANNA GIDLOF
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Credential | RDHAP
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Telephone | 760-625-3708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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