Provider Demographics
NPI:1598535189
Name:SMILE LAB LLC
Entity Type:Organization
Organization Name:SMILE LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:ESTEFANIA
Authorized Official - Last Name:LLAURADOR CARABALLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-840-0080
Mailing Address - Street 1:2431 BLVD LUIS A FERRE STE 202
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2115
Mailing Address - Country:US
Mailing Address - Phone:787-840-0080
Mailing Address - Fax:
Practice Address - Street 1:2431 BLVD LUIS A FERRE STE 202
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2115
Practice Address - Country:US
Practice Address - Phone:787-840-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental