Provider Demographics
NPI:1508458266
Name:HEALTHY SMILE DENTISTRY
Entity Type:Organization
Organization Name:HEALTHY SMILE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:THU
Authorized Official - Last Name:PHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-248-8242
Mailing Address - Street 1:27186 NEWPORT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7385
Mailing Address - Country:US
Mailing Address - Phone:951-248-8242
Mailing Address - Fax:
Practice Address - Street 1:27186 NEWPORT RD STE 1
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7385
Practice Address - Country:US
Practice Address - Phone:951-248-8242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental