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General NPI Number Information
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NPI Number | 1417497330
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Entity Type | Organization
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Legal Business Name | I SMILE DENTAL GROUP
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 2710 N GRAND AVE
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City | SANTA ANA
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State | CA
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Zip | 92705-8750
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Country | US
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Telephone | 171-460-2632
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Fax | 714-602-6275
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Provider Business Mailing Address
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Address Line | 2710 N GRAND AVE
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City | SANTA ANA
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State | CA
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Zip | 92705-8750
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Country | US
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Telephone | 171-460-2632
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Fax | 714-602-6275
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. TU QUYNH NGUYEN
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Credential | DDS
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Telephone | 17146026327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 49617
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License Number State | CA
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