Provider Demographics
NPI:1336809870
Name:PROFESSIONAL SMILE STUDIO
Entity Type:Organization
Organization Name:PROFESSIONAL SMILE STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KHATEREH
Authorized Official - Middle Name:N/A
Authorized Official - Last Name:TOLOOEI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-897-6469
Mailing Address - Street 1:1732 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2105
Mailing Address - Country:US
Mailing Address - Phone:916-333-5903
Mailing Address - Fax:
Practice Address - Street 1:1732 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2105
Practice Address - Country:US
Practice Address - Phone:916-333-5903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-24
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental