Provider Demographics
NPI:1053484584
Name:COMMUNITY DENTAL SERVICES
Entity Type:Organization
Organization Name:COMMUNITY DENTAL SERVICES
Other - Org Name:SMILECARE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALCIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-708-5308
Mailing Address - Street 1:2 MACARTHUR PL
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-5924
Mailing Address - Country:US
Mailing Address - Phone:714-708-5308
Mailing Address - Fax:714-708-5399
Practice Address - Street 1:PACIFIC PLAZA BLDG 20845
Practice Address - Street 2:SUITE 109
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5020
Practice Address - Country:US
Practice Address - Phone:760-430-4445
Practice Address - Fax:760-430-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty