Provider Demographics
NPI:1578807038
Name:SMILE HEALTH SOLUTIONS
Entity Type:Organization
Organization Name:SMILE HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CALLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-477-6700
Mailing Address - Street 1:1350 W ROBINHOOD DR
Mailing Address - Street 2:SUITE 20
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5512
Mailing Address - Country:US
Mailing Address - Phone:209-477-6700
Mailing Address - Fax:800-420-5168
Practice Address - Street 1:1350 W ROBINHOOD DR
Practice Address - Street 2:SUITE 20
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5512
Practice Address - Country:US
Practice Address - Phone:209-477-6700
Practice Address - Fax:800-420-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
35230122300000X
CA352301223P0221X, 1223X0008X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Multi-Specialty