Provider Demographics
NPI:1447919899
Name:SMYLE ESSENTIALS DENTAL HYGIENE PRACTICE OF STEPHANIE GORDILLO, RDHAP
Entity type:Organization
Organization Name:SMYLE ESSENTIALS DENTAL HYGIENE PRACTICE OF STEPHANIE GORDILLO, RDHAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDHAP/SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-862-1367
Mailing Address - Street 1:606 RUBY RD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-5146
Mailing Address - Country:US
Mailing Address - Phone:510-703-5357
Mailing Address - Fax:
Practice Address - Street 1:22268 FOOTHILL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2723
Practice Address - Country:US
Practice Address - Phone:510-703-5357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental