Provider Demographics
NPI:1942537352
Name:SMILE IMPLANT CENTER
Entity Type:Organization
Organization Name:SMILE IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TEICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-732-1992
Mailing Address - Street 1:100 BAYVIEW CIRCLE
Mailing Address - Street 2:SOUTH TOWER, SUITE 600
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-732-1992
Mailing Address - Fax:949-509-7681
Practice Address - Street 1:100 BAYVIEW CIRCLE
Practice Address - Street 2:SOUTH TOWER, SUITE 600
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-732-1992
Practice Address - Fax:949-509-7681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49682292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory