Provider Demographics
NPI:1588031751
Name:A PLUS DENTAL SMILES OF LAKELAND, PLLC
Entity Type:Organization
Organization Name:A PLUS DENTAL SMILES OF LAKELAND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-600-9944
Mailing Address - Street 1:3615 S FLORIDA AVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4876
Mailing Address - Country:US
Mailing Address - Phone:863-646-7587
Mailing Address - Fax:
Practice Address - Street 1:3615 S FLORIDA AVE
Practice Address - Street 2:SUITE 850
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4876
Practice Address - Country:US
Practice Address - Phone:863-646-7587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty