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Organization
SMILE DENTAL
Active
Organization
SMILE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAD RADULOVICH DDS (DENTIST/OWNER)
(310) 204-6661
Entity
Organization
Contact information
Practice address
10920 VENICE BLVD, CULVER CITY, CA 90232-3809
(310) 204-6661
(310) 204-6662
Mailing address
10920 VENICE BLVD, CULVER CITY, CA 90232-3809
(310) 204-6661
(310) 204-6662
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
44531
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679643001
NPI TYPE 1
CA
05
—
B44531-01
—
CA
Enumeration date
07/16/2007
Last updated
07/16/2007
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