Provider Demographics
NPI:1255775649
Name:SIMPLY SMILE ORTHODONTICS OF PEMBROKE PINES, LLC
Entity type:Organization
Organization Name:SIMPLY SMILE ORTHODONTICS OF PEMBROKE PINES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:ORPHANOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-477-7171
Mailing Address - Street 1:9291 GLADES RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3959
Mailing Address - Country:US
Mailing Address - Phone:561-477-7171
Mailing Address - Fax:561-477-7577
Practice Address - Street 1:700 N HIATUS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5206
Practice Address - Country:US
Practice Address - Phone:954-973-5725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMPLY SMILE ORTHODONTICS OF PEMBROKE PINES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty