Provider Demographics
NPI:1639514045
Name:SMILE DESIGN STUDIO INC
Entity Type:Organization
Organization Name:SMILE DESIGN STUDIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:FALCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:407-804-0770
Mailing Address - Street 1:1331 S INTERNATIONAL PKWY
Mailing Address - Street 2:SUITE 2271
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1405
Mailing Address - Country:US
Mailing Address - Phone:407-804-0770
Mailing Address - Fax:407-804-0773
Practice Address - Street 1:1331 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 2271
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1405
Practice Address - Country:US
Practice Address - Phone:407-804-0770
Practice Address - Fax:407-804-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12688122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty