Provider Demographics
NPI:1275944167
Name:JUST SMILE DENTAL CENTER,DENTAL GROUP OF ADONIS REGALA,D.D.S., INC
Entity Type:Organization
Organization Name:JUST SMILE DENTAL CENTER,DENTAL GROUP OF ADONIS REGALA,D.D.S., INC
Other - Org Name:JUST SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ADONIS
Authorized Official - Middle Name:MANALO
Authorized Official - Last Name:REGALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-251-1400
Mailing Address - Street 1:1269 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2043
Mailing Address - Country:US
Mailing Address - Phone:213-251-1400
Mailing Address - Fax:
Practice Address - Street 1:1269 S UNION AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2043
Practice Address - Country:US
Practice Address - Phone:213-251-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty