Provider Demographics
NPI:1508641895
Name:SMILE MISSION CENTRAL ORLANDO PLLC
Entity Type:Organization
Organization Name:SMILE MISSION CENTRAL ORLANDO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PFUNDHELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-701-8246
Mailing Address - Street 1:9900 SW 168TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5700 N ORANGE BLOSSOM TRL STE 270
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-1023
Practice Address - Country:US
Practice Address - Phone:786-701-8246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental