Provider Demographics
NPI:1912248147
Name:HEALTHY SMILES, PA
Entity type:Organization
Organization Name:HEALTHY SMILES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-353-1001
Mailing Address - Street 1:3200 SW 34TH AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7456
Mailing Address - Country:US
Mailing Address - Phone:352-372-5437
Mailing Address - Fax:352-867-5437
Practice Address - Street 1:3200 SW 34TH AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7456
Practice Address - Country:US
Practice Address - Phone:352-372-5437
Practice Address - Fax:352-867-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004605100Medicaid