Provider Demographics
NPI:1629458583
Name:DENTAL SMILE THERAPY, PA
Entity Type:Organization
Organization Name:DENTAL SMILE THERAPY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RAFAELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA-PINTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-785-1102
Mailing Address - Street 1:1901 N. FEDERAL HIGHWAY UNIT 215
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062
Mailing Address - Country:US
Mailing Address - Phone:954-785-1102
Mailing Address - Fax:
Practice Address - Street 1:1901 N FEDERAL HWY UNIT 215
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1000
Practice Address - Country:US
Practice Address - Phone:954-785-1102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18323261QD0000X
FLDN19480261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental