Provider Demographics
NPI:1598500688
Name:SMILES TAMPA DENTAL CARE INC
Entity type:Organization
Organization Name:SMILES TAMPA DENTAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:REVOREDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-587-9930
Mailing Address - Street 1:5200 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1408
Mailing Address - Country:US
Mailing Address - Phone:813-333-9992
Mailing Address - Fax:
Practice Address - Street 1:5200 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1408
Practice Address - Country:US
Practice Address - Phone:813-333-9992
Practice Address - Fax:813-515-9158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental