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General NPI Number Information
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NPI Number | 1619151149
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Entity Type | Organization
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Legal Business Name | PERFECT SMILES FAMILY DENTISTRY
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 9260 ALCOSTA BLVD SUITE B-10
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City | SAN RAMON
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State | CA
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Zip | 94583-4134
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Country | US
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Telephone | 925-833-8702
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Fax | 925-833-3750
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Provider Business Mailing Address
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Address Line | 9260 ALCOSTA BLVD SUITE B-10
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City | SAN RAMON
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State | CA
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Zip | 94583-4134
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Country | US
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Telephone | 925-833-8702
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Fax | 925-833-3750
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | ROCHELLE KENNEDY BARACEROS
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Credential |
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Telephone | 925-833-8702
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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 | 55561
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License Number State | CA
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