Provider Demographics
NPI:1467683631
Name:KEEP SMILING BRACES, LLC
Entity type:Organization
Organization Name:KEEP SMILING BRACES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:O
Authorized Official - Last Name:LUX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-300-6598
Mailing Address - Street 1:3411 TAMIAMI TRL N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3700
Mailing Address - Country:US
Mailing Address - Phone:239-300-6598
Mailing Address - Fax:
Practice Address - Street 1:3411 TAMIAMI TRL N
Practice Address - Street 2:SUITE 200
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3700
Practice Address - Country:US
Practice Address - Phone:850-264-7135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental