Provider Demographics
NPI:1346606290
Name:SMILE DENTISTRY ASSOCIATES LLC
Entity Type:Organization
Organization Name:SMILE DENTISTRY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-270-5505
Mailing Address - Street 1:9055 SW 87TH AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2306
Mailing Address - Country:US
Mailing Address - Phone:305-270-5505
Mailing Address - Fax:305-270-0455
Practice Address - Street 1:9055 SW 87TH AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2306
Practice Address - Country:US
Practice Address - Phone:305-270-5505
Practice Address - Fax:305-270-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004941600Medicaid