Provider Demographics
NPI:1275673683
Name:FAMILY SMILE DENTISTRY P.A.
Entity Type:Organization
Organization Name:FAMILY SMILE DENTISTRY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DORA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:JARQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-345-1100
Mailing Address - Street 1:9090 58TH DR E STE 300
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6112
Mailing Address - Country:US
Mailing Address - Phone:941-345-1100
Mailing Address - Fax:941-345-1099
Practice Address - Street 1:9090 58TH DR E STE 300
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-6112
Practice Address - Country:US
Practice Address - Phone:941-345-1100
Practice Address - Fax:941-345-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN145941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty