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General NPI Number Information
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NPI Number | 1912306721
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Entity Type | Organization
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Legal Business Name | DANA POINT SMILES
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 24655 LA PLZ SUITE E
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City | DANA POINT
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State | CA
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Zip | 92629-2583
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Country | US
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Telephone | 949-496-5713
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Fax |
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Provider Business Mailing Address
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Address Line | 24655 LA PLZ SUITE E
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City | DANA POINT
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State | CA
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Zip | 92629-2583
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Country | US
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Telephone | 949-496-5713
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KIMBERLY A EVANS
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Credential |
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Telephone | 949-496-5713
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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 | 29647
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License Number State | CA
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