Provider Demographics
NPI:1871855452
Name:SMILES ON THE RUN DENTAL HYGIENE PRACTICE OF KIMBERLY FARRELL RDHAP
Entity type:Organization
Organization Name:SMILES ON THE RUN DENTAL HYGIENE PRACTICE OF KIMBERLY FARRELL RDHAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDHAP / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:949-637-8911
Mailing Address - Street 1:26895 ALISO CREEK RD STE B671
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5301
Mailing Address - Country:US
Mailing Address - Phone:949-637-8911
Mailing Address - Fax:
Practice Address - Street 1:26895 ALISO CREEK RD STE B671
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5301
Practice Address - Country:US
Practice Address - Phone:949-637-8911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP103251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH00103OtherDENTICAL