| Dental Smile Studio | |
|
484 E Los Angeles Ave 210 Moorpark CA 93021-1900 | |
| (805) 532-1101 | |
| (805) 532-1834 |
| Full Name | Dental Smile Studio |
|---|---|
| Speciality | Dentist |
| Location | 484 E Los Angeles Ave, Moorpark, California |
| Authorized Official Name and Position | Rodrick Ghadimi (PRESIDENT) |
| Authorized Official Contact | 8055321101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Smile Studio 484 E Los Angeles Ave 210 Moorpark CA 93021-1900 Ph: (805) 532-1101 | Dental Smile Studio 484 E Los Angeles Ave 210 Moorpark CA 93021-1900 Ph: (805) 532-1101 |
| NPI Number | 1619254059 |
|---|---|
| Provider Enumeration Date | 11/14/2011 |
| Last Update Date | 04/22/2019 |
| Medicare PECOS PAC ID | 8123368362 |
|---|---|
| Medicare Enrollment ID | O20191007001848 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619254059 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 52606 (California) | Primary |
| 122300000X | Dentist | 52575 (California) | Secondary |
| Provider Name | Rodrick Ghadimi |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1427263409 PECOS PAC ID: 5294024568 Enrollment ID: I20200327001645 |
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