Provider Demographics
NPI:1508578576
Name:SMILING TEAM CORP
Entity Type:Organization
Organization Name:SMILING TEAM CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENNYS
Authorized Official - Middle Name:N
Authorized Official - Last Name:RUSSO DE ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-655-6413
Mailing Address - Street 1:14201 W SUNRISE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3207
Mailing Address - Country:US
Mailing Address - Phone:954-652-1504
Mailing Address - Fax:
Practice Address - Street 1:14201 W SUNRISE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3207
Practice Address - Country:US
Practice Address - Phone:954-652-1504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1821626094OtherDENTIST NPI