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General NPI Number Information
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NPI Number | 1649498684
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Entity Type | Organization
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Legal Business Name | SMILE POWER
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 2121 YGNACIO VALLEY RD BUILDING F
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City | WALNUT CREEK
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State | CA
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Zip | 94598-3383
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Country | US
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Telephone | 925-937-1333
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Fax | 925-937-6149
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Provider Business Mailing Address
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Address Line | 2121 YGNACIO VALLEY RD BUILDING F
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City | WALNUT CREEK
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State | CA
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Zip | 94598-3383
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Country | US
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Telephone | 925-937-1333
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Fax | 925-937-6149
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Authorized Official
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Title or Position | OWNER
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Name | BRIDGET MARIE POWERS
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Credential | DDS
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Telephone | 925-937-1333
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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 | 43062
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License Number State | CA
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