Provider Demographics
NPI:1487989240
Name:MIAMI CHILDREN'S SMILES, P.A
Entity type:Organization
Organization Name:MIAMI CHILDREN'S SMILES, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:AURORA
Authorized Official - Last Name:ROLLAND-ASENSI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-445-9244
Mailing Address - Street 1:3850 BIRD RD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1501
Mailing Address - Country:US
Mailing Address - Phone:305-445-9244
Mailing Address - Fax:305-445-9245
Practice Address - Street 1:3850 BIRD RD
Practice Address - Street 2:SUITE #301
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33146-1501
Practice Address - Country:US
Practice Address - Phone:305-445-9244
Practice Address - Fax:305-445-9245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN164341223P0221X
FLDN217001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016814400Medicaid