Provider Demographics
NPI:1790232205
Name:ISMILE DENTAL GROUP OF REBECCA S. AHLERS, DDS. INC.
Entity Type:Organization
Organization Name:ISMILE DENTAL GROUP OF REBECCA S. AHLERS, DDS. INC.
Other - Org Name:SURF CITY FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:AHLERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-602-6327
Mailing Address - Street 1:18377 BEACH BLVD STE 328
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1350
Mailing Address - Country:US
Mailing Address - Phone:714-602-6327
Mailing Address - Fax:714-602-6275
Practice Address - Street 1:18377 BEACH BLVD STE 328
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1350
Practice Address - Country:US
Practice Address - Phone:714-602-6327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345691223G0001X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty