Provider Demographics
NPI:1447417001
Name:SMILE STUDIO FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SMILE STUDIO FAMILY DENTISTRY
Other - Org Name:GALVAN-EXCONDE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:HALILI
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-818-9648
Mailing Address - Street 1:3906 DECOTO RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3114
Mailing Address - Country:US
Mailing Address - Phone:510-818-9648
Mailing Address - Fax:510-818-9748
Practice Address - Street 1:3906 DECOTO RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-3114
Practice Address - Country:US
Practice Address - Phone:510-818-9648
Practice Address - Fax:510-818-9748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty