| Smile Wide | |
|
172 E Carson St Carson CA 90745-2702 | |
| (310) 618-1522 | |
| (310) 618-9272 |
| Full Name | Smile Wide |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 172 E Carson St, Carson, California |
| Authorized Official Name and Position | Daniel Harvey Lee (PRESIDENT) |
| Authorized Official Contact | 9495968100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Smile Wide 19762 Macarthur Blvd 100 Irvine CA 92612-2424 Ph: (949) 596-8100 | Smile Wide 172 E Carson St Carson CA 90745-2702 Ph: (310) 618-1522 |
| NPI Number | 1619411329 |
|---|---|
| Provider Enumeration Date | 12/14/2016 |
| Last Update Date | 12/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619411329 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 56861 (California) | Primary |
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