Provider Demographics
NPI:1205592086
Name:A1A SMILES, PA
Entity type:Organization
Organization Name:A1A SMILES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-394-2873
Mailing Address - Street 1:3830 S HIGHWAY A1A
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951
Mailing Address - Country:US
Mailing Address - Phone:305-394-2874
Mailing Address - Fax:
Practice Address - Street 1:3830 S HIGHWAY A1A
Practice Address - Street 2:SUITE 1
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951
Practice Address - Country:US
Practice Address - Phone:321-728-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty