Provider Demographics
NPI:1225519903
Name:ARROW SMILE DENTAL A PRACTICE OF VICTOR M ROSALES DDS INC
Entity Type:Organization
Organization Name:ARROW SMILE DENTAL A PRACTICE OF VICTOR M ROSALES DDS INC
Other - Org Name:ARROW SMILE DENTAL A PRACTICE OF VICTOR M ROSALES,DDS.INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:MAGPILI
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-938-1236
Mailing Address - Street 1:20530 E ARROW HWY STE A
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1238
Mailing Address - Country:US
Mailing Address - Phone:626-938-1236
Mailing Address - Fax:
Practice Address - Street 1:8363 RESEDA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5908
Practice Address - Country:US
Practice Address - Phone:818-405-0278
Practice Address - Fax:626-938-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55369261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental