Provider Demographics
NPI:1992133136
Name:HEALTHY SMILES PERIODONTICS & IMPLANT DENTISTRY INC
Entity type:Organization
Organization Name:HEALTHY SMILES PERIODONTICS & IMPLANT DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:ACONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:424-263-4919
Mailing Address - Street 1:3220 SEPULVEDA BLVD
Mailing Address - Street 2:101
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:424-263-4919
Mailing Address - Fax:424-263-4921
Practice Address - Street 1:3220 SEPULVEDA BLVD
Practice Address - Street 2:101
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2744
Practice Address - Country:US
Practice Address - Phone:424-263-4919
Practice Address - Fax:424-263-4921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-25
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508791223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty