Provider Demographics
NPI:1336691542
Name:SIMPLE SMILES LLC
Entity Type:Organization
Organization Name:SIMPLE SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:LLEO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-381-5412
Mailing Address - Street 1:18400 NW 75TH PL STE 121
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2958
Mailing Address - Country:US
Mailing Address - Phone:305-381-5412
Mailing Address - Fax:786-360-2404
Practice Address - Street 1:18400 NW 75TH PL STE 121
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2958
Practice Address - Country:US
Practice Address - Phone:305-381-5412
Practice Address - Fax:786-360-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07599110Medicaid