Provider Demographics
NPI:1376841361
Name:KIDS SMILE PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:KIDS SMILE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMINOLLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-776-2899
Mailing Address - Street 1:3142 VISTA WAY STE 305
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3629
Mailing Address - Country:US
Mailing Address - Phone:760-529-9846
Mailing Address - Fax:760-529-9846
Practice Address - Street 1:3142 VISTA WAY STE 305
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3629
Practice Address - Country:US
Practice Address - Phone:760-529-9846
Practice Address - Fax:760-529-9846
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMINOLLAH BAGHERI, DDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA563401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty