Provider Demographics
NPI:1104214865
Name:SEA OF SMILES, INC.
Entity Type:Organization
Organization Name:SEA OF SMILES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LAPRESTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-528-8717
Mailing Address - Street 1:3737 MARYWEATHER LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7779
Mailing Address - Country:US
Mailing Address - Phone:813-528-8717
Mailing Address - Fax:813-528-8728
Practice Address - Street 1:3737 MARYWEATHER LN
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7779
Practice Address - Country:US
Practice Address - Phone:813-528-8717
Practice Address - Fax:813-528-8728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DN174301223P0221X
DN146771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076529500Medicaid