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General NPI Number Information
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NPI Number | 1457550816
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Entity Type | Organization
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Legal Business Name | NEW SMILE DENTAL
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 405 S LA BREA AVE
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City | INGLEWOOD
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State | CA
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Zip | 90301-2321
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Country | US
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Telephone | 310-674-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 405 S LA BREA AVE
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City | INGLEWOOD
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State | CA
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Zip | 90301-2321
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Country | US
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Telephone | 310-674-5555
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Fax |
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Authorized Official
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Title or Position | GENERAL DOCTOR
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Name | DR. MICHAEL DOUNEL
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Credential | D.M.D
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Telephone | 310-674-5555
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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 | 54602
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License Number State | CA
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