Provider Demographics
NPI:1013229616
Name:ISMILE DENTAL CARE
Entity Type:Organization
Organization Name:ISMILE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:GO
Authorized Official - Last Name:UY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-290-2931
Mailing Address - Street 1:128 LAKEWOOD CENTER MALL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2420
Mailing Address - Country:US
Mailing Address - Phone:562-531-7788
Mailing Address - Fax:
Practice Address - Street 1:128 LAKEWOOD CENTER MALL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2420
Practice Address - Country:US
Practice Address - Phone:562-531-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty