MEDICARE: FAMILY SMILES

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

General Provider Information

NPI Number	:	1548408859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY SMILES

Provider Business Mailing Address
First Line	:	444 W MINER ST
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-2839
Country	:	US
Telephone Number	:	530-842-7323
Fax Number	:	530-842-4320

Provider Business Practice Location Address
First Line	:	444 W MINER ST
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-2839
Country	:	US
Telephone Number	:	530-842-7323
Fax Number	:	530-842-4320

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. TREVOR RAGAN
Credential	:	DDS
Telephone Number	:	530-842-7323

Provider Enumeration Date	:	01/23/2009
Last Update Date	:	01/23/2009

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Directions to “FAMILY SMILES ” Practice Location

Language	Start Address	Practice Location

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