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General NPI Number Information
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NPI Number | 1992133136
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILES PERIODONTICS & IMPLANT DENTISTRY INC
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Dates
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Enumeration Date | 10/25/2013
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Last Update Date | 02/28/2014
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Provider Practice Location Address
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Address Line | 3220 SEPULVEDA BLVD 101
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City | TORRANCE
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State | CA
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Zip | 90505-2744
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Country | US
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Telephone | 424-263-4919
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Fax | 424-263-4921
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Provider Business Mailing Address
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Address Line | 3220 SEPULVEDA BLVD 101
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City | TORRANCE
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State | CA
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Zip | 90505
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Country | US
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Telephone | 424-263-4919
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Fax | 424-263-4921
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER L ACONE
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Credential | D.D.S.
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Telephone | 424-263-4919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 50879
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License Number State | CA
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