Provider Demographics
NPI:1669193017
Name:SMILE DENTAL
Entity type:Organization
Organization Name:SMILE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:NEW
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-364-2958
Mailing Address - Street 1:6817 BALBOA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4592
Mailing Address - Country:US
Mailing Address - Phone:818-786-2040
Mailing Address - Fax:
Practice Address - Street 1:6817 BALBOA BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-4592
Practice Address - Country:US
Practice Address - Phone:818-786-2040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT F NEW III DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-05
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental