Provider Demographics
NPI:1679972525
Name:GIVING SMILES
Entity type:Organization
Organization Name:GIVING SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:916-934-8527
Mailing Address - Street 1:2410 FAIR OAKS BLVD
Mailing Address - Street 2:#120
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-7663
Mailing Address - Country:US
Mailing Address - Phone:916-934-8527
Mailing Address - Fax:
Practice Address - Street 1:2410 FAIR OAKS BLVD
Practice Address - Street 2:#120
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-7663
Practice Address - Country:US
Practice Address - Phone:916-934-8527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06332101Y00000X
CAL11402552101YP1600X
CA38494122300000X
CA133N00000X
174H00000X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty