Provider Demographics
NPI:1083842553
Name:INNOVATION DENTISTRY, PL
Entity Type:Organization
Organization Name:INNOVATION DENTISTRY, PL
Other - Org Name:NONA SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:YASBECK
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-808-6662
Mailing Address - Street 1:9145 NARCOOSSEE RD
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-5768
Mailing Address - Country:US
Mailing Address - Phone:407-808-6662
Mailing Address - Fax:407-601-7966
Practice Address - Street 1:9145 NARCOOSSEE RD
Practice Address - Street 2:SUITE A-100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-5768
Practice Address - Country:US
Practice Address - Phone:407-808-6662
Practice Address - Fax:407-601-7966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty