Provider Demographics
NPI: | 1346968260 |
---|---|
Name: | JUPITER SMILE CARE DENTISTRY DMD LLC |
Entity Type: | Organization |
Organization Name: | JUPITER SMILE CARE DENTISTRY DMD LLC |
Other - Org Name: | CHRISTIANE MURILLO DMD LLC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER/DENTIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CHRISTIANE |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | MURILLO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 561-844-0715 |
Mailing Address - Street 1: | 4600 MILITARY TRL STE 219 |
Mailing Address - Street 2: | |
Mailing Address - City: | JUPITER |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33458-4813 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-844-0715 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4600 MILITARY TRL STE 219 |
Practice Address - Street 2: | |
Practice Address - City: | JUPITER |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33458-4813 |
Practice Address - Country: | US |
Practice Address - Phone: | 561-844-0715 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-08-16 |
Last Update Date: | 2023-02-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |