Provider Demographics
NPI:1194326843
Name:STELLAR SMILES INC.
Entity type:Organization
Organization Name:STELLAR SMILES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-894-1098
Mailing Address - Street 1:1050 AUDACE AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3354
Mailing Address - Country:US
Mailing Address - Phone:646-894-1098
Mailing Address - Fax:
Practice Address - Street 1:9070 KIMBERLY BLVD STE 51
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2861
Practice Address - Country:US
Practice Address - Phone:561-990-2934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-07
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty