Provider Demographics
NPI:1073945556
Name:HEALTHY SMILES FAMILY DENTAL
Entity Type:Organization
Organization Name:HEALTHY SMILES FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINTHIA
Authorized Official - Middle Name:MORALES
Authorized Official - Last Name:ANDAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-919-2322
Mailing Address - Street 1:150 S GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3038
Mailing Address - Country:US
Mailing Address - Phone:626-919-2322
Mailing Address - Fax:
Practice Address - Street 1:150 S GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3038
Practice Address - Country:US
Practice Address - Phone:626-919-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53574261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental