Provider Demographics
NPI:1689225997
Name:BIG BOCA SMILES LLC
Entity Type:Organization
Organization Name:BIG BOCA SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:E. ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOONT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-482-8000
Mailing Address - Street 1:21301 POWERLINE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2390
Mailing Address - Country:US
Mailing Address - Phone:561-482-8000
Mailing Address - Fax:
Practice Address - Street 1:21301 POWERLINE RD STE 208
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2390
Practice Address - Country:US
Practice Address - Phone:561-482-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty