Provider Demographics
NPI:1336691260
Name:SMILE AT MARGATE
Entity Type:Organization
Organization Name:SMILE AT MARGATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-974-4400
Mailing Address - Street 1:5404 W ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5209
Mailing Address - Country:US
Mailing Address - Phone:954-974-4400
Mailing Address - Fax:954-974-4402
Practice Address - Street 1:5404 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063
Practice Address - Country:US
Practice Address - Phone:954-974-4400
Practice Address - Fax:954-974-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN193811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004189300Medicaid