Your Great Smile,Inc. a Dental Hygiene Practice of Vange Leonis, Rdhap

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

HAP47 Issued in CA

Legal business name

YOUR GREAT SMILE,INC. A DENTAL HYGIENE PRACTICE OF VANGE LEONIS, RDHAP

Practice address

900 Saint Andrews Dr
Rio Vista, CA 94571-9707

Phone

(415) 898-7390

Fax

(415) 898-7389

NPI assigned

Feb 7, 2018

Last updated

Feb 7, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vange Irene Leonis, RDHAPNPI 1841355401

Title

President

Phone

(415) 898-7390

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vange Irene Leonis, RDHAP

  • Dental Hygienist
  • Novato, CA
  • NPI 1841355401
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517961600000",
    "number": "1679072417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "926A DIABLO AVE # 122",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949474025",
            "telephone_number": "415-898-7390",
            "fax_number": "415-898-7389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SAINT ANDREWS DR",
            "city": "RIO VISTA",
            "state": "CA",
            "postal_code": "945719707",
            "telephone_number": "415-898-7390",
            "fax_number": "415-898-7389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUR GREAT SMILE,INC. A DENTAL HYGIENE PRACTICE OF VANGE LEONIS, RDHAP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-07",
        "last_updated": "2018-02-07",
        "status": "A",
        "authorized_official_last_name": "LEONIS",
        "authorized_official_first_name": "VANGE",
        "authorized_official_middle_name": "IRENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "415-898-7390",
        "authorized_official_credential": "RDHAP"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "HAP47",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841355401",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leann Walker
• Nancy Karen West-Thompson, ASW
• Roderick Williams, LMSW
• Sharonda Williams, PPC
• Kenneth Alan Wudel, PHARM D

• Dental Clinic/Center in Rio Vista, CA
• Providers in Rio Vista, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.