Provider Demographics
NPI:1750804266
Name:SIGNATURE SMILES PRACTICE OF OWJI
Entity type:Organization
Organization Name:SIGNATURE SMILES PRACTICE OF OWJI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:MOHMMAD
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:OWJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-298-3384
Mailing Address - Street 1:255 W BULLARD AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0861
Mailing Address - Country:US
Mailing Address - Phone:559-298-3384
Mailing Address - Fax:
Practice Address - Street 1:255 W BULLARD AVE STE 106
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0861
Practice Address - Country:US
Practice Address - Phone:559-298-3384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53844261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental