Provider Demographics
NPI:1427565043
Name:AVENTURA IRRESISTIBLE SMILES PA
Entity Type:Organization
Organization Name:AVENTURA IRRESISTIBLE SMILES PA
Other - Org Name:AVENTURA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CISMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-935-4030
Mailing Address - Street 1:20475 BISCAYNE BLVD # G9
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1550
Mailing Address - Country:US
Mailing Address - Phone:305-935-4030
Mailing Address - Fax:
Practice Address - Street 1:20475 BISCAYNE BLVD # G9
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1550
Practice Address - Country:US
Practice Address - Phone:305-935-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty