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General NPI Number Information
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NPI Number | 1578807038
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Entity Type | Organization
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Legal Business Name | SMILE HEALTH SOLUTIONS
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Dates
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Enumeration Date | 11/21/2012
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 1350 W ROBINHOOD DR SUITE 20
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City | STOCKTON
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State | CA
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Zip | 95207-5512
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Country | US
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Telephone | 209-477-6700
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Fax | 800-420-5168
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Provider Business Mailing Address
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Address Line | 1350 W ROBINHOOD DR SUITE 20
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City | STOCKTON
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State | CA
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Zip | 95207-5512
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Country | US
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Telephone | 209-477-6700
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Fax | 800-420-5168
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Authorized Official
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Title or Position | MANAGING ORTHODONTIST
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Name | RALPH A CALLENDER
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Credential | DDS
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Telephone | 209-477-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 35230
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 35230
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number | 35230
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 35230
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License Number State | CA
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