Provider Demographics
NPI: | 1568060937 |
---|---|
Name: | SMILING KIDDS DENTISTRY, P.A. |
Entity Type: | Organization |
Organization Name: | SMILING KIDDS DENTISTRY, P.A. |
Other - Org Name: | HAPPY FRIENDLY SMILES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | ANDREW |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WEAVER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 904-395-7772 |
Mailing Address - Street 1: | 3020 HARTLEY RD STE 210 |
Mailing Address - Street 2: | |
Mailing Address - City: | JACKSONVILLE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32257-8206 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1319 E OSCEOLA PKWY STE C |
Practice Address - Street 2: | |
Practice Address - City: | KISSIMMEE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34744-1606 |
Practice Address - Country: | US |
Practice Address - Phone: | 407-343-0509 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | SMILING KIDDS DENTISTRY, P.A. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2020-10-16 |
Last Update Date: | 2023-06-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223P0221X | Dental Providers | Dentist | Pediatric Dentistry | Group - Single Specialty |