Provider Demographics
NPI:1013503184
Name:PURE SMILES, PA
Entity Type:Organization
Organization Name:PURE SMILES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVERA CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-881-1751
Mailing Address - Street 1:3195 QUEEN ALEXANDRIA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9103
Mailing Address - Country:US
Mailing Address - Phone:407-881-1751
Mailing Address - Fax:
Practice Address - Street 1:8185 LEE VISTA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8304
Practice Address - Country:US
Practice Address - Phone:407-881-1751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental