Provider Demographics
NPI:1124804307
Name:SMILE PERFECT DENTAL STUDIO, INC
Entity type:Organization
Organization Name:SMILE PERFECT DENTAL STUDIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-557-6711
Mailing Address - Street 1:10511 N KENDALL DR STE C101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1537
Mailing Address - Country:US
Mailing Address - Phone:305-557-6711
Mailing Address - Fax:
Practice Address - Street 1:10511 N KENDALL DR STE C101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1537
Practice Address - Country:US
Practice Address - Phone:305-557-6711
Practice Address - Fax:305-681-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty