Provider Demographics
NPI:1114333218
Name:NUSMILE DENTAL- SEMINOLE
Entity Type:Organization
Organization Name:NUSMILE DENTAL- SEMINOLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-393-6962
Mailing Address - Street 1:13611 PARK BLVD
Mailing Address - Street 2:STE. G
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-3437
Mailing Address - Country:US
Mailing Address - Phone:727-393-6962
Mailing Address - Fax:813-837-2381
Practice Address - Street 1:13611 PARK BLVD
Practice Address - Street 2:STE. G
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-3437
Practice Address - Country:US
Practice Address - Phone:727-393-6962
Practice Address - Fax:813-837-2381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62266OtherBCBS OF FL