Provider Demographics
NPI:1952063596
Name:SERENITY SMILES
Entity Type:Organization
Organization Name:SERENITY SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LLERENA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-890-5372
Mailing Address - Street 1:17339 MEADOW LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-2546
Mailing Address - Country:US
Mailing Address - Phone:305-890-5372
Mailing Address - Fax:
Practice Address - Street 1:28441 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-3212
Practice Address - Country:US
Practice Address - Phone:239-317-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental