Provider Demographics
NPI:1255703260
Name:NEW SMILES DENTAL ASSOCIATES
Entity type:Organization
Organization Name:NEW SMILES DENTAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-717-7779
Mailing Address - Street 1:14138 SW 8TH ST # 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-3105
Mailing Address - Country:US
Mailing Address - Phone:786-717-7779
Mailing Address - Fax:786-522-0595
Practice Address - Street 1:14138 SW 8TH ST # 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3105
Practice Address - Country:US
Practice Address - Phone:786-717-7779
Practice Address - Fax:786-522-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty