Provider Demographics
NPI:1073079778
Name:ALL SMILES CHILDRENS DENTISTRY PA
Entity Type:Organization
Organization Name:ALL SMILES CHILDRENS DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TEDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-503-1607
Mailing Address - Street 1:1340 E ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-4343
Mailing Address - Country:US
Mailing Address - Phone:425-503-1607
Mailing Address - Fax:
Practice Address - Street 1:1340 E ORANGE AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4343
Practice Address - Country:US
Practice Address - Phone:425-503-1607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty