Provider Demographics
NPI:1003893363
Name:EXPERT SMILES CENTER
Entity Type:Organization
Organization Name:EXPERT SMILES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-826-3255
Mailing Address - Street 1:2750 W 68TH ST
Mailing Address - Street 2:STE 108
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-826-3255
Mailing Address - Fax:305-826-3898
Practice Address - Street 1:2750 W 68TH ST
Practice Address - Street 2:STE 108
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-826-3255
Practice Address - Fax:305-826-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty