Provider Demographics
NPI:1528533627
Name:BEAUTIFUL SMILES, INC
Entity type:Organization
Organization Name:BEAUTIFUL SMILES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOKRIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-881-8884
Mailing Address - Street 1:1419 SUPERIOR AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1419 SUPERIOR AVE STE 6
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2723
Practice Address - Country:US
Practice Address - Phone:949-646-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental