Provider Demographics
NPI:1386036325
Name:CHARLES B SMURTHWAITE, D.D.S., INC.
Entity Type:Organization
Organization Name:CHARLES B SMURTHWAITE, D.D.S., INC.
Other - Org Name:SMILE QUEST DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMURTHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-797-8511
Mailing Address - Street 1:6500 LONETREE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5874
Mailing Address - Country:US
Mailing Address - Phone:916-797-8511
Mailing Address - Fax:916-797-8508
Practice Address - Street 1:6500 LONETREE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5874
Practice Address - Country:US
Practice Address - Phone:916-797-8511
Practice Address - Fax:916-797-8508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty