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General NPI Number Information
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NPI Number | 1447919899
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Entity Type | Organization
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Legal Business Name | SMYLE ESSENTIALS DENTAL HYGIENE PRACTICE OF STEPHANIE GORDILLO, RDHAP
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Dates
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Enumeration Date | 12/14/2021
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 22268 FOOTHILL BLVD STE 2
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City | HAYWARD
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State | CA
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Zip | 94541-2723
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Country | US
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Telephone | 510-703-5357
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Fax |
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Provider Business Mailing Address
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Address Line | 606 RUBY RD
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City | LIVERMORE
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State | CA
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Zip | 94550-5146
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Country | US
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Telephone | 510-703-5357
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Fax |
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Authorized Official
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Title or Position | RDHAP/SECRETARY
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Name | MRS. CYNTHIA M DILLON
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Credential |
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Telephone | 510-862-1367
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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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