Provider Demographics
NPI:1770106411
Name:SMILEXP PLLC
Entity type:Organization
Organization Name:SMILEXP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:CARLO
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DN23339
Authorized Official - Phone:703-341-7769
Mailing Address - Street 1:1993 DANIELS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4598
Mailing Address - Country:US
Mailing Address - Phone:407-395-9335
Mailing Address - Fax:407-395-8470
Practice Address - Street 1:1993 DANIELS RD STE 120
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4598
Practice Address - Country:US
Practice Address - Phone:407-395-9335
Practice Address - Fax:407-395-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental