MEDICARE: ALL SMILE DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	43914	CA

General Provider Information

NPI Number	:	1114011020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL SMILE DENTAL

Provider Business Mailing Address
First Line	:	4653 CARMEL MOUNTAIN RD
Second Line	:	STE. 306
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-6650
Country	:	US
Telephone Number	:	858-350-0045
Fax Number	:	858-228-4367

Provider Business Practice Location Address
First Line	:	4653 CARMEL MOUNTAIN RD
Second Line	:	STE. 306
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-6650
Country	:	US
Telephone Number	:	858-350-0045
Fax Number	:	858-228-4367

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTY CHEN
Credential	:
Telephone Number	:	858-350-0045

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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Directions to “ALL SMILE DENTAL ” Practice Location

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