| NPI | 1750980140 |
|---|---|
| Doing Business As | CORONA SMILE SHOPPE |
| Entity Type | Organization |
| Authorized Contact | JUAN GERARDO MARTINEZ Director 510-697-1029 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2020-10-19 |