Provider Demographics
NPI:1386034635
Name:HEALTHY SMILES DENTAL OF PALM COAST LLC
Entity Type:Organization
Organization Name:HEALTHY SMILES DENTAL OF PALM COAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENCHIMOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-283-4902
Mailing Address - Street 1:1264 PALM COAST PARKWAY SW
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137
Mailing Address - Country:US
Mailing Address - Phone:386-283-4902
Mailing Address - Fax:386-283-4961
Practice Address - Street 1:1264 PALM COAST PKWY SW
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4700
Practice Address - Country:US
Practice Address - Phone:386-283-4902
Practice Address - Fax:386-283-4961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18114122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty