Provider Demographics
NPI:1467055566
Name:TRUSMILE DENTAL HYGIENE PRACTICE OF KIM, INC.
Entity Type:Organization
Organization Name:TRUSMILE DENTAL HYGIENE PRACTICE OF KIM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA ANTONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:951-922-4975
Mailing Address - Street 1:66 S SAN GORGONIO AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-6020
Mailing Address - Country:US
Mailing Address - Phone:951-553-8235
Mailing Address - Fax:
Practice Address - Street 1:66 S SAN GORGONIO AVE STE 5
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-6020
Practice Address - Country:US
Practice Address - Phone:951-922-4975
Practice Address - Fax:951-922-4976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty