Provider Demographics
NPI:1407040108
Name:U SMILE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:U SMILE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-428-0114
Mailing Address - Street 1:7171 BOWLING DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7171 BOWLING DR STE 210
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2043
Practice Address - Country:US
Practice Address - Phone:916-428-0114
Practice Address - Fax:916-428-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53996302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93858-01OtherMEDICAL DENTI-CAL