Provider Demographics
NPI:1184447906
Name:SIGNATURE SMILES OF TAMPA, PLLC
Entity type:Organization
Organization Name:SIGNATURE SMILES OF TAMPA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:KHANTIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-302-9282
Mailing Address - Street 1:3814 WEST BAY VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1226
Mailing Address - Country:US
Mailing Address - Phone:813-302-9282
Mailing Address - Fax:813-302-9342
Practice Address - Street 1:3814 WEST BAY VISTA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1226
Practice Address - Country:US
Practice Address - Phone:813-302-9282
Practice Address - Fax:813-302-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty