Provider Demographics
NPI:1255752515
Name:ARROW SMILE DENTAL A PRACTICE OF VICTOR M ROSALES,DDS, INCORPORATED
Entity type:Organization
Organization Name:ARROW SMILE DENTAL A PRACTICE OF VICTOR M ROSALES,DDS, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:MAGPILI
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-938-1236
Mailing Address - Street 1:20530 E ARROW HWY STE A
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1238
Mailing Address - Country:US
Mailing Address - Phone:626-938-1236
Mailing Address - Fax:
Practice Address - Street 1:20530 E ARROW HWY STE A
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1238
Practice Address - Country:US
Practice Address - Phone:626-938-1236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55369261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental