| Magic Smile Family Dentistry | |
|
12703 Prairie Ave Hawthorne CA 90250-4612 | |
| (310) 676-2442 | |
| Not Available |
| Full Name | Magic Smile Family Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12703 Prairie Ave, Hawthorne, California |
| Authorized Official Name and Position | Martha Ligia Gutierrez (OWNER MANAGING DENTIST) |
| Authorized Official Contact | 3106762442 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Magic Smile Family Dentistry 12703 Prairie Ave Hawthorne CA 90250-4612 Ph: (310) 676-2442 | Magic Smile Family Dentistry 12703 Prairie Ave Hawthorne CA 90250-4612 Ph: (310) 676-2442 |
| NPI Number | 1912116971 |
|---|---|
| Provider Enumeration Date | 05/22/2007 |
| Last Update Date | 11/14/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912116971 | NPI | - | NPPES |
| D44176 | Other | CA | MEDICAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D44176 (California) | Primary |
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