Provider Demographics
NPI:1225588395
Name:MENCITA DABU MASANGKAY DMD INC.
Entity Type:Organization
Organization Name:MENCITA DABU MASANGKAY DMD INC.
Other - Org Name:SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MENCITA
Authorized Official - Middle Name:DABU
Authorized Official - Last Name:MASANGKAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-672-1770
Mailing Address - Street 1:500 ALFRED NOBEL DR
Mailing Address - Street 2:SUITE 145
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1838
Mailing Address - Country:US
Mailing Address - Phone:510-741-7788
Mailing Address - Fax:510-741-7705
Practice Address - Street 1:500 ALFRED NOBEL DR
Practice Address - Street 2:SUITE 145
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1838
Practice Address - Country:US
Practice Address - Phone:510-741-7788
Practice Address - Fax:510-741-7705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty