Provider Demographics
NPI:1790658219
Name:GOOD SMILES LLC
Entity type:Organization
Organization Name:GOOD SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CERTEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-456-3832
Mailing Address - Street 1:801 WOODSIDE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3751
Mailing Address - Country:US
Mailing Address - Phone:630-456-3832
Mailing Address - Fax:
Practice Address - Street 1:801 WOODSIDE RD STE 3
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3751
Practice Address - Country:US
Practice Address - Phone:630-456-3832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty