Provider Demographics
NPI:1932650322
Name:JAVID DENTAL CORPORATION
Entity Type:Organization
Organization Name:JAVID DENTAL CORPORATION
Other - Org Name:DR. SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYVON
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-325-8555
Mailing Address - Street 1:24667 CRENSHAW BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5360
Mailing Address - Country:US
Mailing Address - Phone:310-325-8555
Mailing Address - Fax:
Practice Address - Street 1:24667 CRENSHAW BLVD STE D
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5360
Practice Address - Country:US
Practice Address - Phone:310-325-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486171223G0001X
261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629413547OtherNPI