Provider Demographics
NPI:1225371693
Name:BEAUTIFUL SMILES P.S.C
Entity Type:Organization
Organization Name:BEAUTIFUL SMILES P.S.C
Other - Org Name:BEAUTYFUL SMILES INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-460-5667
Mailing Address - Street 1:PO BOX 50712
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-0712
Mailing Address - Country:US
Mailing Address - Phone:787-795-2048
Mailing Address - Fax:787-261-6677
Practice Address - Street 1:610 AVE. COMERIO SUERMERCADOS ECONO
Practice Address - Street 2:LEVITTOWN
Practice Address - City:LEVITTOWN
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-795-2048
Practice Address - Fax:787-261-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2529261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental