Provider Demographics
NPI:1871043018
Name:SOUTH FAMILIA DENTAL PA
Entity Type:Organization
Organization Name:SOUTH FAMILIA DENTAL PA
Other - Org Name:SMILE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:SANGALANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-240-2255
Mailing Address - Street 1:12720 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:STE 22
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6225
Mailing Address - Country:US
Mailing Address - Phone:407-240-2255
Mailing Address - Fax:
Practice Address - Street 1:12720 S ORANGE BLOSSOM TRL
Practice Address - Street 2:STE 22
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6225
Practice Address - Country:US
Practice Address - Phone:407-240-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19152261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental