Provider Demographics
NPI:1992210488
Name:DE SOUSA & MANIGLIA DMD, PA
Entity Type:Organization
Organization Name:DE SOUSA & MANIGLIA DMD, PA
Other - Org Name:SMILE SOLUTIONS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE SOUSA DMD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-432-3655
Mailing Address - Street 1:8200 W. 33RD AVE
Mailing Address - Street 2:#STE 5
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018
Mailing Address - Country:US
Mailing Address - Phone:954-432-3655
Mailing Address - Fax:954-438-0334
Practice Address - Street 1:8200 W. 33RD AVE STE 5
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:954-432-3655
Practice Address - Fax:954-438-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19465122300000X
FLDN19470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty