Provider Demographics
NPI:1649437518
Name:CARLSBADDS PEDIATRIC SMILES
Entity type:Organization
Organization Name:CARLSBADDS PEDIATRIC SMILES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-379-6694
Mailing Address - Street 1:1285 CARLSBAD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1950
Mailing Address - Country:US
Mailing Address - Phone:760-730-3456
Mailing Address - Fax:
Practice Address - Street 1:1285 CARLSBAD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1950
Practice Address - Country:US
Practice Address - Phone:760-730-3456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA514491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty