Provider Demographics
NPI:1437291101
Name:SMILES 4 FAMILY DENTAL OFFICE, P.S.C.
Entity Type:Organization
Organization Name:SMILES 4 FAMILY DENTAL OFFICE, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO-MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-707-3378
Mailing Address - Street 1:ESTANCIAS SIERVAS DE MARIA
Mailing Address - Street 2:64 CALLE SANTA ANA
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9314
Mailing Address - Country:US
Mailing Address - Phone:787-703-3378
Mailing Address - Fax:787-703-3378
Practice Address - Street 1:VALLE TOLIMA
Practice Address - Street 2:G 38 AVE. PRINCIPAL
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-703-3378
Practice Address - Fax:787-703-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD026441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty