Provider Demographics
NPI:1578944286
Name:BRANDON SMILES,LLC
Entity Type:Organization
Organization Name:BRANDON SMILES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANANGER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:MARCELA
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-438-8728
Mailing Address - Street 1:926 W LUMSDEN RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6281
Mailing Address - Country:US
Mailing Address - Phone:813-438-8728
Mailing Address - Fax:813-438-8730
Practice Address - Street 1:926 W LUMSDEN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6281
Practice Address - Country:US
Practice Address - Phone:813-438-8728
Practice Address - Fax:813-438-8730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL HEALTH EXPERT LL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-18
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization