Provider Demographics
NPI:1255361903
Name:SMILEWORKS DENTAL GROUP
Entity type:Organization
Organization Name:SMILEWORKS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL-MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-261-7500
Mailing Address - Street 1:62 CORPORATE PARK
Mailing Address - Street 2:STE 210
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606
Mailing Address - Country:US
Mailing Address - Phone:949-261-7500
Mailing Address - Fax:949-261-7502
Practice Address - Street 1:62 CORPORATE PARK
Practice Address - Street 2:STE 210
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606
Practice Address - Country:US
Practice Address - Phone:949-261-7500
Practice Address - Fax:949-261-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty