| NPI | 1124689302 |
|---|---|
| Doing Business As | SMILES OF LA MESA |
| Entity Type | Organization |
| Authorized Contact | PRASAD GONAVARUM President/Owner 630-788-5833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2019-06-27 |