Provider Demographics
NPI:1407215965
Name:SMILES KINGDOM INC
Entity Type:Organization
Organization Name:SMILES KINGDOM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:D
Authorized Official - Last Name:TABORDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:386-299-5625
Mailing Address - Street 1:3751 CLYDE MORRIS BLVD
Mailing Address - Street 2:UNIT 7
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-2356
Mailing Address - Country:US
Mailing Address - Phone:386-310-3060
Mailing Address - Fax:386-872-5021
Practice Address - Street 1:3751 CLYDE MORRIS BLVD
Practice Address - Street 2:UNIT 7
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-2356
Practice Address - Country:US
Practice Address - Phone:386-310-3060
Practice Address - Fax:386-872-5021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TABORDA DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19830122300000X
FLDN21034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty