Provider Demographics
NPI:1114468394
Name:SMILES BY DESIGN
Entity Type:Organization
Organization Name:SMILES BY DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-940-6808
Mailing Address - Street 1:1779 S PINELLAS AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-1920
Mailing Address - Country:US
Mailing Address - Phone:727-940-6808
Mailing Address - Fax:727-940-6669
Practice Address - Street 1:1779 S PINELLAS AVE
Practice Address - Street 2:STE 100
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1920
Practice Address - Country:US
Practice Address - Phone:727-940-6808
Practice Address - Fax:727-940-6669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8609261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental