Provider Demographics
NPI:1720292949
Name:HEALTHY SMILES FOR KIDS OF ORANGE COUNTY
Entity Type:Organization
Organization Name:HEALTHY SMILES FOR KIDS OF ORANGE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN, JD
Authorized Official - Phone:714-537-0700
Mailing Address - Street 1:10602 CHAPMAN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-3103
Mailing Address - Country:US
Mailing Address - Phone:714-537-0700
Mailing Address - Fax:714-537-0733
Practice Address - Street 1:10602 CHAPMAN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3103
Practice Address - Country:US
Practice Address - Phone:714-537-0700
Practice Address - Fax:714-537-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5500001061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG94040-01OtherMEDI-CAL
CAG94040-01OtherDENTI-CAL