Provider Demographics
NPI:1023453321
Name:BIG SMILE DENTISTRY INC
Entity type:Organization
Organization Name:BIG SMILE DENTISTRY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAYANA
Authorized Official - Middle Name:YOLANI
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-331-3013
Mailing Address - Street 1:9880 VIA BERNINI
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6939
Mailing Address - Country:US
Mailing Address - Phone:561-331-3013
Mailing Address - Fax:
Practice Address - Street 1:4481 LAKE WORTH RD STE B
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3929
Practice Address - Country:US
Practice Address - Phone:561-331-3013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN157991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherHMO AND PPO