Provider Demographics
NPI:1568170850
Name:PLANTATION SMILE CARE DMD INC
Entity Type:Organization
Organization Name:PLANTATION SMILE CARE DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DISHA
Authorized Official - Middle Name:DIPAK
Authorized Official - Last Name:MANKAME
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-260-5341
Mailing Address - Street 1:300 NW 70TH AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2360
Mailing Address - Country:US
Mailing Address - Phone:954-791-1630
Mailing Address - Fax:
Practice Address - Street 1:300 NW 70TH AVE STE 108
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2360
Practice Address - Country:US
Practice Address - Phone:954-791-1630
Practice Address - Fax:954-916-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental