Provider Demographics
NPI:1548568074
Name:SMILES ON CITRUS PL
Entity Type:Organization
Organization Name:SMILES ON CITRUS PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-795-1881
Mailing Address - Street 1:535 N CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-4016
Mailing Address - Country:US
Mailing Address - Phone:352-795-1881
Mailing Address - Fax:352-795-7081
Practice Address - Street 1:535 N CITRUS AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-4016
Practice Address - Country:US
Practice Address - Phone:352-795-1881
Practice Address - Fax:352-795-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN177981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty