Provider Demographics
NPI:1255597530
Name:AESTHETIC SMILE DENTAL CENTER
Entity type:Organization
Organization Name:AESTHETIC SMILE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILOU
Authorized Official - Middle Name:S
Authorized Official - Last Name:TOQUERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-496-1888
Mailing Address - Street 1:3203 CARSON ST
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-4006
Mailing Address - Country:US
Mailing Address - Phone:562-496-1888
Mailing Address - Fax:562-496-0688
Practice Address - Street 1:3203 CARSON ST
Practice Address - Street 2:SUITE # 2
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-4006
Practice Address - Country:US
Practice Address - Phone:562-496-1888
Practice Address - Fax:562-496-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54432261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental