Provider Demographics
NPI:1669156436
Name:COSMETIC SMILES DENTAL CARE LLC
Entity type:Organization
Organization Name:COSMETIC SMILES DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDORF
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTERO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-916-7616
Mailing Address - Street 1:10101 E BAY HARBOR DR APT 309
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1201
Mailing Address - Country:US
Mailing Address - Phone:786-916-7616
Mailing Address - Fax:
Practice Address - Street 1:11300 NW 87TH CT STE 166
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4521
Practice Address - Country:US
Practice Address - Phone:305-364-9322
Practice Address - Fax:305-364-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery