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General NPI Number Information
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NPI Number | 1942537352
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Entity Type | Organization
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Legal Business Name | SMILE IMPLANT CENTER
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Dates
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Enumeration Date | 11/05/2009
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 100 BAYVIEW CIRCLE SOUTH TOWER, SUITE 600
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 949-732-1992
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Fax | 949-509-7681
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Provider Business Mailing Address
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Address Line | 100 BAYVIEW CIRCLE SOUTH TOWER, SUITE 600
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 949-732-1992
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Fax | 949-509-7681
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THOMAS J TEICH
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Credential | DDS
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Telephone | 949-732-1992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number | 49682
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License Number State | CA
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