Provider Demographics
NPI:1558544627
Name:ARROW SMILE DENTAL A PRACTICE OF VICTOR M ROSALES DDS INC
Entity Type:Organization
Organization Name:ARROW SMILE DENTAL A PRACTICE OF VICTOR M ROSALES DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-938-1236
Mailing Address - Street 1:20530 E ARROW HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1238
Mailing Address - Country:US
Mailing Address - Phone:626-938-1236
Mailing Address - Fax:626-938-1234
Practice Address - Street 1:20530 E ARROW HWY
Practice Address - Street 2:SUITE A
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1238
Practice Address - Country:US
Practice Address - Phone:626-938-1236
Practice Address - Fax:626-938-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55369261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental