Provider Demographics
NPI:1265644348
Name:CENTRAL FLORIDA SMILES, INC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA SMILES, INC
Other - Org Name:SAVASTANO & DUNN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SAVASTANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD,MS
Authorized Official - Phone:407-862-1870
Mailing Address - Street 1:2855 W SR 434
Mailing Address - Street 2:SUITE 1011
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779
Mailing Address - Country:US
Mailing Address - Phone:407-862-1870
Mailing Address - Fax:407-682-7004
Practice Address - Street 1:2855 W SR 434
Practice Address - Street 2:SUITE 1011
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779
Practice Address - Country:US
Practice Address - Phone:407-862-1870
Practice Address - Fax:407-682-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67761223X0400X
FL154871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9006776OtherDELTA DENTAL PROVIDER#
FL86838OtherBCBS PROVIDER#
FL1953103OtherUNITED CONCORDIA PROVIDER
FL553680OtherUNITED CONCORDIA #
FL592036601OtherTAX ID #
FLBD8677760OtherDEA#
FLBS9026279OtherDEA #