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General NPI Number Information
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NPI Number | 1528576394
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Entity Type | Organization
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Legal Business Name | JONAH AND CALEB SMILE PARTNERSHIP
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 01/16/2018
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Provider Practice Location Address
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Address Line | 7170 INDIANA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92504-4544
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Country | US
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Telephone | 951-248-0567
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Fax |
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Provider Business Mailing Address
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Address Line | 5394 WALNUT AVE STE H
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City | IRVINE
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State | CA
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Zip | 92604-2591
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Country | US
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Telephone | 949-262-9567
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. TRANG THUY NGUYEN
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Credential | DDS, MS
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Telephone | 714-251-1614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 56206
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 58041
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License Number State | CA
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