Provider Demographics
NPI:1730650839
Name:SMILE FAMILY DENTAL GROUP LLC
Entity Type:Organization
Organization Name:SMILE FAMILY DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CABAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-509-7949
Mailing Address - Street 1:1900 CORAL WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2661
Mailing Address - Country:US
Mailing Address - Phone:305-509-7949
Mailing Address - Fax:305-459-7578
Practice Address - Street 1:1900 CORAL WAY STE 200
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2661
Practice Address - Country:US
Practice Address - Phone:305-509-7949
Practice Address - Fax:305-459-7578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty