Provider Demographics
NPI:1023290822
Name:THE SMILE FACTORY OF THE TIEMPO DE LOS NINOS
Entity type:Organization
Organization Name:THE SMILE FACTORY OF THE TIEMPO DE LOS NINOS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-318-2465
Mailing Address - Street 1:100 S SUNRISE WAY
Mailing Address - Street 2:A-409
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6778
Mailing Address - Country:US
Mailing Address - Phone:760-318-2465
Mailing Address - Fax:760-406-6155
Practice Address - Street 1:1140 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4872
Practice Address - Country:US
Practice Address - Phone:760-318-2465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG98491-01OtherDELTA DENTAL