Provider Demographics
NPI:1477085603
Name:REDWOOD SMILES
Entity type:Organization
Organization Name:REDWOOD SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEERTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-369-3695
Mailing Address - Street 1:PO BOX 340129
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-0129
Mailing Address - Country:US
Mailing Address - Phone:916-419-9939
Mailing Address - Fax:
Practice Address - Street 1:160 BIRCH ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1307
Practice Address - Country:US
Practice Address - Phone:650-369-3695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1003981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100398OtherDENTAL LICENSE