Provider Demographics
NPI:1083344709
Name:FAMILY SMILES OF COCONUT CREEK, PLLC
Entity Type:Organization
Organization Name:FAMILY SMILES OF COCONUT CREEK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMALTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-735-9898
Mailing Address - Street 1:6746 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4332
Mailing Address - Country:US
Mailing Address - Phone:954-951-5755
Mailing Address - Fax:
Practice Address - Street 1:6746 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4332
Practice Address - Country:US
Practice Address - Phone:954-951-5755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental