Provider Demographics
NPI:1326686312
Name:LASTING SMILES OF ORLANDO LLC
Entity Type:Organization
Organization Name:LASTING SMILES OF ORLANDO LLC
Other - Org Name:SERENE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DHARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-434-0243
Mailing Address - Street 1:275 S CHICKASAW TRL STE 2
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3505
Mailing Address - Country:US
Mailing Address - Phone:716-239-5889
Mailing Address - Fax:
Practice Address - Street 1:275 S CHICKASAW TRL STE 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3505
Practice Address - Country:US
Practice Address - Phone:716-239-5889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty