Provider Demographics
NPI:1508286048
Name:SMILE 4 KIDS, PEDIATRIC DENTISTRY, CSP
Entity Type:Organization
Organization Name:SMILE 4 KIDS, PEDIATRIC DENTISTRY, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-567-5437
Mailing Address - Street 1:35 CALLE JUAN C BORBON STE 67
Mailing Address - Street 2:PMB 384
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5375
Mailing Address - Country:US
Mailing Address - Phone:787-567-5437
Mailing Address - Fax:787-999-0137
Practice Address - Street 1:1 AVE ARBOLOTE
Practice Address - Street 2:PLAZA REAL SHOPPING CENTER, SUITE 205
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-2806
Practice Address - Country:US
Practice Address - Phone:787-567-5437
Practice Address - Fax:787-999-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20571223P0221X
PR22791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty