Provider Demographics
NPI:1932308145
Name:SMILE DESIGNS BY CHARLOTTE GERRY
Entity Type:Organization
Organization Name:SMILE DESIGNS BY CHARLOTTE GERRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:386-755-7010
Mailing Address - Street 1:857 SW MAIN BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024
Mailing Address - Country:US
Mailing Address - Phone:386-755-7010
Mailing Address - Fax:386-755-7024
Practice Address - Street 1:857 SW MAIN BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024
Practice Address - Country:US
Practice Address - Phone:386-755-7010
Practice Address - Fax:386-755-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty