Provider Demographics
NPI:1376902502
Name:SIMPLY SMILES ORTHODONTICS
Entity Type:Organization
Organization Name:SIMPLY SMILES ORTHODONTICS
Other - Org Name:PARKLAND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINT AMAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-350-7264
Mailing Address - Street 1:7633 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3524
Mailing Address - Country:US
Mailing Address - Phone:561-350-7264
Mailing Address - Fax:866-892-0774
Practice Address - Street 1:7633 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33073-3524
Practice Address - Country:US
Practice Address - Phone:561-350-7264
Practice Address - Fax:866-892-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1255595765OtherNPI TYPE 1