Provider Demographics
NPI:1598160145
Name:NEW SMILE DENTISTRY OF ALTAMONTE SPRINGS, PA
Entity Type:Organization
Organization Name:NEW SMILE DENTISTRY OF ALTAMONTE SPRINGS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FIRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROUF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-767-8000
Mailing Address - Street 1:512 E ALTAMONTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701
Mailing Address - Country:US
Mailing Address - Phone:407-767-8000
Mailing Address - Fax:407-767-8010
Practice Address - Street 1:512 E ALTAMONTE DRIVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:407-767-8000
Practice Address - Fax:407-767-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty