Provider Demographics
NPI:1851091961
Name:BLOOMING SMILES HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:BLOOMING SMILES HEALTH SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BORYS
Authorized Official - Middle Name:GILBERTO
Authorized Official - Last Name:JIMENEZ RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-542-9827
Mailing Address - Street 1:12150 SW 128TH CT STE 142
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4673
Mailing Address - Country:US
Mailing Address - Phone:305-542-9827
Mailing Address - Fax:
Practice Address - Street 1:12150 SW 128TH CT STE 142
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4673
Practice Address - Country:US
Practice Address - Phone:305-542-9827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty