Provider Demographics
NPI:1437013851
Name:RADIANT SMILES PEDIATRIC DENTISTRY, PLLC
Entity type:Organization
Organization Name:RADIANT SMILES PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CLEOPHAS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-328-3122
Mailing Address - Street 1:6519 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7567
Mailing Address - Country:US
Mailing Address - Phone:813-328-3122
Mailing Address - Fax:813-328-3072
Practice Address - Street 1:6519 STADIUM DR
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7567
Practice Address - Country:US
Practice Address - Phone:813-328-3122
Practice Address - Fax:813-328-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-10
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty