Provider Demographics
NPI:1245976000
Name:SEA OF SMILES 2, PLLC
Entity type:Organization
Organization Name:SEA OF SMILES 2, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPRESTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-953-1001
Mailing Address - Street 1:5442 LAND O LAKES BLVD.
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639
Mailing Address - Country:US
Mailing Address - Phone:813-953-1001
Mailing Address - Fax:813-953-1018
Practice Address - Street 1:5442 LAND O LAKES BLVD.
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639
Practice Address - Country:US
Practice Address - Phone:813-953-1001
Practice Address - Fax:813-953-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental