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General NPI Number Information
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NPI Number | 1528250412
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Entity Type | Organization
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Legal Business Name | SMILENEEDS DENTAL
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 1183 E FOOTHILL BLVD SUITE150
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City | UPLAND
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State | CA
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Zip | 91786-4079
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Country | US
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Telephone | 909-466-1245
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Fax | 909-912-8245
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Provider Business Mailing Address
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Address Line | 1183 E FOOTHILL BLVD SUITE150
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City | UPLAND
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State | CA
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Zip | 91786-4079
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Country | US
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Telephone | 909-466-1245
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Fax | 909-912-8245
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIANO CASTRO
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Credential | DDS
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Telephone | 906-466-1245
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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 |
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License Number State |
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