MEDICARE: ZENITH SMILES SERIES 3,LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1528861812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZENITH SMILES SERIES 3,LLC

Provider Business Mailing Address
First Line	:	104 W 7TH ST STE 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90014-1906
Country	:	US
Telephone Number	:	213-688-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 W 7TH ST STE 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90014-1906
Country	:	US
Telephone Number	:	213-688-2828
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL MANAGER
Name	:	MATTHEW YOUNG
Credential	:
Telephone Number	:	435-559-1247

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	04/01/2025

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