Provider Demographics
NPI:1083966451
Name:SMILE CENTER SILICON VALLEY
Entity Type:Organization
Organization Name:SMILE CENTER SILICON VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ASHTON
Authorized Official - Last Name:VELLEQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-245-7500
Mailing Address - Street 1:877 W FREMONT AVE
Mailing Address - Street 2:SUITE L3
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2315
Mailing Address - Country:US
Mailing Address - Phone:408-245-7500
Mailing Address - Fax:408-746-5820
Practice Address - Street 1:877 W FREMONT AVE
Practice Address - Street 2:SUITE L3
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2315
Practice Address - Country:US
Practice Address - Phone:408-245-7500
Practice Address - Fax:408-746-5820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty