Provider Demographics
NPI:1013139633
Name:WYNDHAMSMITH AND KIM, APROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:WYNDHAMSMITH AND KIM, APROFESSIONAL DENTAL CORPORATION
Other - Org Name:VALENCIA MEDICAL AND DENTAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WYNDHAMSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-795-9328
Mailing Address - Street 1:28097 SMYTH DR. SUITE C
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355
Mailing Address - Country:US
Mailing Address - Phone:661-799-0925
Mailing Address - Fax:661-291-1423
Practice Address - Street 1:28097 SMYTH DR. SUITE C
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:661-291-1412
Practice Address - Fax:661-291-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA461951223E0200X
CA411221223P0300X
CA493121223S0112X
CA323841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty