Provider Demographics
NPI:1033261896
Name:CALIFORNIA SMILE - PLEASANT HILL PC
Entity Type:Organization
Organization Name:CALIFORNIA SMILE - PLEASANT HILL PC
Other - Org Name:CALIFORNIA SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SON
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-689-2748
Mailing Address - Street 1:565 CONTRA COSTA BOULEVARD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1259
Mailing Address - Country:US
Mailing Address - Phone:925-689-2748
Mailing Address - Fax:925-689-2476
Practice Address - Street 1:565 CONTRA COSTA BOULEVARD
Practice Address - Street 2:SUITE B
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1259
Practice Address - Country:US
Practice Address - Phone:925-689-2748
Practice Address - Fax:925-689-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty