Provider Demographics
NPI:1497134902
Name:LOOP SMILE GROUP
Entity Type:Organization
Organization Name:LOOP SMILE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-477-7655
Mailing Address - Street 1:7902 NW 36TH ST STE 209
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6663
Mailing Address - Country:US
Mailing Address - Phone:305-477-7655
Mailing Address - Fax:305-477-7654
Practice Address - Street 1:7902 NW 36TH ST STE 209
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6663
Practice Address - Country:US
Practice Address - Phone:305-477-7655
Practice Address - Fax:305-477-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty