Provider Demographics
NPI:1295044725
Name:MY SMILE DENTAL INC DBA ADVANTAGE DENTAL CARE
Entity Type:Organization
Organization Name:MY SMILE DENTAL INC DBA ADVANTAGE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-748-9393
Mailing Address - Street 1:520 48TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5508
Mailing Address - Country:US
Mailing Address - Phone:941-748-9393
Mailing Address - Fax:941-748-9696
Practice Address - Street 1:520 48TH STREET CT E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5508
Practice Address - Country:US
Practice Address - Phone:941-748-9393
Practice Address - Fax:941-748-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty