Provider Demographics
NPI:1629504972
Name:NICE SMILE DENTAL LLC
Entity Type:Organization
Organization Name:NICE SMILE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATUTE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-530-3705
Mailing Address - Street 1:4519 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3449
Mailing Address - Country:US
Mailing Address - Phone:561-530-3705
Mailing Address - Fax:
Practice Address - Street 1:4519 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3449
Practice Address - Country:US
Practice Address - Phone:561-530-3705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty