Provider Demographics
NPI:1972048874
Name:SMILE DESIGN CENTER
Entity type:Organization
Organization Name:SMILE DESIGN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:321-751-7775
Mailing Address - Street 1:5445 VILLAGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6666
Mailing Address - Country:US
Mailing Address - Phone:321-751-7775
Mailing Address - Fax:
Practice Address - Street 1:5445 VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6666
Practice Address - Country:US
Practice Address - Phone:321-751-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-31
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15965122300000X
FLDN20180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty