Provider Demographics
NPI:1003233396
Name:ADVENTURE SMILES PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:ADVENTURE SMILES PEDIATRIC DENTISTRY
Other - Org Name:ADVENTURE SMILES PEDIATRIC DENTISTRY AND ORTHODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-792-6272
Mailing Address - Street 1:5714 21ST AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5606
Mailing Address - Country:US
Mailing Address - Phone:941-792-6272
Mailing Address - Fax:
Practice Address - Street 1:5714 21ST AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5606
Practice Address - Country:US
Practice Address - Phone:941-792-6272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19243261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental