Provider Demographics
NPI:1114116001
Name:NALORN NANG SENGAMPHAN,DDS, INC.
Entity Type:Organization
Organization Name:NALORN NANG SENGAMPHAN,DDS, INC.
Other - Org Name:INFINITI SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NALORN
Authorized Official - Middle Name:NANG
Authorized Official - Last Name:SENGAMPHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-679-0520
Mailing Address - Street 1:27851 BRADLEY RD
Mailing Address - Street 2:155
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2286
Mailing Address - Country:US
Mailing Address - Phone:951-679-0520
Mailing Address - Fax:951-679-8274
Practice Address - Street 1:27851 BRADLEY RD
Practice Address - Street 2:155
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2286
Practice Address - Country:US
Practice Address - Phone:951-679-0520
Practice Address - Fax:951-679-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty