Provider Demographics
NPI:1770779852
Name:CECIL B SMITH D.D.S. INC.
Entity type:Organization
Organization Name:CECIL B SMITH D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMERA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-677-1565
Mailing Address - Street 1:101 N LA BREA AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1791
Mailing Address - Country:US
Mailing Address - Phone:310-677-1565
Mailing Address - Fax:310-677-7095
Practice Address - Street 1:101 N LA BREA AVE STE 402
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1791
Practice Address - Country:US
Practice Address - Phone:310-677-1565
Practice Address - Fax:310-677-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36613261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3661301OtherDENTI-CAL