Provider Demographics
NPI:1740841865
Name:LEESBURG SMILES
Entity type:Organization
Organization Name:LEESBURG SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSHAREEF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-831-1203
Mailing Address - Street 1:604 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6834
Mailing Address - Country:US
Mailing Address - Phone:407-831-1203
Mailing Address - Fax:407-831-9716
Practice Address - Street 1:8305 COUNTY ROAD 44 LEG A # 1
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3706
Practice Address - Country:US
Practice Address - Phone:407-831-1203
Practice Address - Fax:407-831-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental