Provider Demographics
NPI:1912306721
Name:DANA POINT SMILES
Entity Type:Organization
Organization Name:DANA POINT SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-496-5713
Mailing Address - Street 1:24655 LA PLZ
Mailing Address - Street 2:SUITE E
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2583
Mailing Address - Country:US
Mailing Address - Phone:949-496-5713
Mailing Address - Fax:
Practice Address - Street 1:24655 LA PLZ
Practice Address - Street 2:SUITE E
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2583
Practice Address - Country:US
Practice Address - Phone:949-496-5713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty