| Smile Wide | |
|
1111 W 6th Street Suite 120 Los Angeles CA 90017-1823 | |
| (213) 895-0009 | |
| (213) 895-0012 |
| Full Name | Smile Wide |
|---|---|
| Speciality | Dentist |
| Location | 1111 W 6th Street, Los Angeles, 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 92612-8275 Ph: (949) 596-8100 | Smile Wide 1111 W 6th Street Suite 120 Los Angeles CA 90017-1823 Ph: (213) 895-0009 |
| NPI Number | 1407246994 |
|---|---|
| Provider Enumeration Date | 02/04/2015 |
| Last Update Date | 11/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407246994 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 56861 (California) | Primary |
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