Provider Demographics
NPI:1225543705
Name:KIDS HEALTHY SMILES LLC
Entity Type:Organization
Organization Name:KIDS HEALTHY SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANADA RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-590-8454
Mailing Address - Street 1:2722 NE 1ST ST STE 1
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4934
Mailing Address - Country:US
Mailing Address - Phone:954-590-8454
Mailing Address - Fax:754-220-6162
Practice Address - Street 1:2722 NE 1ST ST STE 1
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4934
Practice Address - Country:US
Practice Address - Phone:954-590-8454
Practice Address - Fax:754-220-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental