Provider Demographics
NPI:1063703627
Name:WIN SMILES DENTAL
Entity type:Organization
Organization Name:WIN SMILES DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:TUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-227-7707
Mailing Address - Street 1:233 W BADILLO ST STE D
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1966
Mailing Address - Country:US
Mailing Address - Phone:909-227-7707
Mailing Address - Fax:323-567-9999
Practice Address - Street 1:233 W BADILLO ST STE D
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1966
Practice Address - Country:US
Practice Address - Phone:909-227-7707
Practice Address - Fax:323-567-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty