| Ismile Dental | |
|
4370 Palm Ave Ste C San Diego CA 92154-1760 | |
| (619) 428-8682 | |
| (619) 428-1043 |
| Full Name | Ismile Dental |
|---|---|
| Speciality | Clinic/Center |
| Location | 4370 Palm Ave Ste C, San Diego, California |
| Authorized Official Name and Position | Michael H Ho (PROVIDER/OWNER) |
| Authorized Official Contact | 6194288682 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ismile Dental 4370 Palm Ave Ste C San Diego CA 92154-1760 Ph: (619) 428-8682 | Ismile Dental 4370 Palm Ave Ste C San Diego CA 92154-1760 Ph: (619) 428-8682 |
| NPI Number | 1477068054 |
|---|---|
| Provider Enumeration Date | 12/05/2017 |
| Last Update Date | 12/05/2017 |
| Medicare PECOS PAC ID | 5698197556 |
|---|---|
| Medicare Enrollment ID | O20200623000142 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477068054 | NPI | - | NPPES |
| 1912146598 | Other | CA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 58067 (California) | Primary |
| Provider Name | Michael Ha-quang Ho |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1912146598 PECOS PAC ID: 3971925835 Enrollment ID: I20200623000119 |
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