Provider Demographics
NPI:1104442995
Name:DELIVERING SMILES INC.
Entity type:Organization
Organization Name:DELIVERING SMILES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-960-2232
Mailing Address - Street 1:PO BOX 27011
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-7011
Mailing Address - Country:US
Mailing Address - Phone:559-960-2232
Mailing Address - Fax:559-431-4349
Practice Address - Street 1:202 W RIVERRIDGE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6958
Practice Address - Country:US
Practice Address - Phone:559-960-2232
Practice Address - Fax:559-431-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700021094Medicaid