Provider Demographics
NPI:1598163339
Name:NWOGENE MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:NWOGENE MANAGEMENT CORPORATION
Other - Org Name:SMILE TECH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GODFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOGENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-256-5936
Mailing Address - Street 1:8615 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2349
Mailing Address - Country:US
Mailing Address - Phone:424-331-5716
Mailing Address - Fax:424-331-5717
Practice Address - Street 1:8615 CRENSHAW BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2349
Practice Address - Country:US
Practice Address - Phone:424-331-5716
Practice Address - Fax:424-331-5717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty