Provider Demographics
NPI:1740524446
Name:A PLUS SMILES CHILDREN'S DENTISTRY, PA
Entity type:Organization
Organization Name:A PLUS SMILES CHILDREN'S DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-481-1969
Mailing Address - Street 1:2406 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2169
Mailing Address - Country:US
Mailing Address - Phone:850-215-7100
Mailing Address - Fax:850-215-7002
Practice Address - Street 1:2335 STATE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4398
Practice Address - Country:US
Practice Address - Phone:850-215-7100
Practice Address - Fax:850-215-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN162801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty