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General NPI Number Information
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NPI Number | 1871855452
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Entity Type | Organization
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Legal Business Name | SMILES ON THE RUN DENTAL HYGIENE PRACTICE OF KIMBERLY FARRELL RDHAP
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 26895 ALISO CREEK RD STE B671
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5301
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Country | US
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Telephone | 949-637-8911
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Fax |
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Provider Business Mailing Address
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Address Line | 26895 ALISO CREEK RD STE B671
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5301
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Country | US
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Telephone | 949-637-8911
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Fax |
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Authorized Official
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Title or Position | RDHAP / OWNER
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Name | KIMBERLY ANN FARRELL
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Credential | RDHAP
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Telephone | 949-637-8911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HAP103
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License Number State | CA
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