Provider Demographics
NPI:1003201914
Name:KAIS CHEBBI DDS INC
Entity Type:Organization
Organization Name:KAIS CHEBBI DDS INC
Other - Org Name:CULVER SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-204-3368
Mailing Address - Street 1:10814 JEFFERSON BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4994
Mailing Address - Country:US
Mailing Address - Phone:310-204-3368
Mailing Address - Fax:310-204-0550
Practice Address - Street 1:10814 JEFFERSON BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4994
Practice Address - Country:US
Practice Address - Phone:310-204-3368
Practice Address - Fax:310-204-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44849261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801285200OtherDENTAL