Provider Demographics
NPI:1205627411
Name:LA SMILES ENDODONTICS
Entity type:Organization
Organization Name:LA SMILES ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAGRAMANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-255-9589
Mailing Address - Street 1:23206 LYONS AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2672
Mailing Address - Country:US
Mailing Address - Phone:661-255-9589
Mailing Address - Fax:
Practice Address - Street 1:23206 LYONS AVE STE 205
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2672
Practice Address - Country:US
Practice Address - Phone:661-255-9589
Practice Address - Fax:661-255-5785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KRISTINA SHAGRAMANOVA DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty