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Organization
MODERN SMILES DENTAL GROUP
Active
Organization
MODERN SMILES DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW MARTINEZ (OFFICE MANAGER / SECRETARY)
(818) 855-9585
Entity
Organization
Contact information
Practice address
827 N HOLLYWOOD WAY # 213, BURBANK, CA 91505-2814
(818) 588-9585
Mailing address
827 N HOLLYWOOD WAY # 213, BURBANK, CA 91505-2814
(818) 588-9585
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
61124
CA
1223G0001X
General Practice Dentistry
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—
Other
Enumeration date
01/03/2012
Last updated
02/24/2012
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