Provider Demographics
NPI:1114011020
Name:ALL SMILE DENTAL
Entity Type:Organization
Organization Name:ALL SMILE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-350-0045
Mailing Address - Street 1:4653 CARMEL MOUNTAIN RD
Mailing Address - Street 2:STE. 306
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6650
Mailing Address - Country:US
Mailing Address - Phone:858-350-0045
Mailing Address - Fax:858-228-4367
Practice Address - Street 1:4653 CARMEL MOUNTAIN RD
Practice Address - Street 2:STE. 306
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-6650
Practice Address - Country:US
Practice Address - Phone:858-350-0045
Practice Address - Fax:858-228-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty