Provider Demographics
NPI:1609212083
Name:SPECIAL CARE 4 SPECIAL SMILES
Entity Type:Organization
Organization Name:SPECIAL CARE 4 SPECIAL SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-354-6211
Mailing Address - Street 1:4566 FLORENCE AVE STE 7-8
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4345
Mailing Address - Country:US
Mailing Address - Phone:323-560-7656
Mailing Address - Fax:
Practice Address - Street 1:4566 FLORENCE AVE STE 7-8
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-4345
Practice Address - Country:US
Practice Address - Phone:323-560-7656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58323251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health