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Organization
SMILE EXPRESS INC.
Active
Organization
SMILE EXPRESS INC.
Active
Other names
Parkridge Dental Spa
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORACEL T JOHNSON DDS (PRINCIPAL PARTNER)
(951) 735-0200
Entity
Organization
Contact information
Practice address
520 E PARKRIDGE AVE, CORONA, CA 92879-1040
(951) 735-0200
Mailing address
520 E PARKRIDGE AVE, CORONA, CA 92879-1040
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
45536
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45536
DENTAL LICENSE
CA
Enumeration date
12/28/2011
Last updated
12/28/2011
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