Provider Demographics
NPI:1972919132
Name:SIMPLY SMILE ORTHODONTICS OF PEMBROKE PINES, LLC
Entity Type:Organization
Organization Name:SIMPLY SMILE ORTHODONTICS OF PEMBROKE PINES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:S
Authorized Official - Last Name:ORPHANOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-477-7171
Mailing Address - Street 1:700 N HIATUS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5206
Mailing Address - Country:US
Mailing Address - Phone:954-973-5725
Mailing Address - Fax:
Practice Address - Street 1:700 N HIATUS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5206
Practice Address - Country:US
Practice Address - Phone:954-973-5725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty