Provider Demographics
NPI:1508295767
Name:FAMILY SMILES PONTE VEDRA
Entity Type:Organization
Organization Name:FAMILY SMILES PONTE VEDRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-543-0568
Mailing Address - Street 1:151 SAWGRASS CORNERS DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3553
Mailing Address - Country:US
Mailing Address - Phone:904-543-0568
Mailing Address - Fax:
Practice Address - Street 1:151 SAWGRASS CORNERS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3553
Practice Address - Country:US
Practice Address - Phone:904-543-0568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 13848122300000X
FLDN19375122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty