Provider Demographics
NPI:1467229286
Name:INFINITE SMILES PA
Entity Type:Organization
Organization Name:INFINITE SMILES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:H
Authorized Official - Last Name:REINO AGOSTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-821-3344
Mailing Address - Street 1:1935 W 60TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7504
Mailing Address - Country:US
Mailing Address - Phone:305-821-3344
Mailing Address - Fax:
Practice Address - Street 1:1935 W 60TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7504
Practice Address - Country:US
Practice Address - Phone:305-821-3344
Practice Address - Fax:305-821-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty