Provider Demographics
NPI:1265200299
Name:PALMETTO SMILE CENTER PA
Entity type:Organization
Organization Name:PALMETTO SMILE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADERAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-827-3926
Mailing Address - Street 1:6500 COW PEN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-7620
Mailing Address - Country:US
Mailing Address - Phone:305-827-3926
Mailing Address - Fax:
Practice Address - Street 1:6500 COW PEN RD STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7620
Practice Address - Country:US
Practice Address - Phone:305-827-3926
Practice Address - Fax:305-827-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty