Organization
YOUR GREAT SMILE,INC. A DENTAL HYGIENE PRACTICE OF VANGE LEONIS, RDHAP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANGE IRENE LEONIS RDHAP (PRESIDENT)
(415) 898-7390
Entity
Organization
Contact information
Practice address
900 SAINT ANDREWS DR, RIO VISTA, CA 94571-9707
(415) 898-7390
(415) 898-7389
Mailing address
926A DIABLO AVE # 122, NOVATO, CA 94947-4025
(415) 898-7390
(415) 898-7389
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
HAP47
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841355401
—
CA
Enumeration date
02/07/2018
Last updated
02/07/2018
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