Provider Demographics
NPI:1154977528
Name:LI'L SUNSHINE SMILES DENTISTRY P.A
Entity type:Organization
Organization Name:LI'L SUNSHINE SMILES DENTISTRY P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-289-1799
Mailing Address - Street 1:4904 EBENSBURG DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1381
Mailing Address - Country:US
Mailing Address - Phone:719-289-1799
Mailing Address - Fax:
Practice Address - Street 1:12950 RACE TRACK RD STE 109
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1304
Practice Address - Country:US
Practice Address - Phone:719-289-1799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023572000Medicaid