Provider Demographics
NPI:1972646610
Name:PERFECT SMILE DENTISTRY
Entity type:Organization
Organization Name:PERFECT SMILE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-204-4494
Mailing Address - Street 1:12300 SOUTHSHORE BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6237
Mailing Address - Country:US
Mailing Address - Phone:561-204-4494
Mailing Address - Fax:561-204-2840
Practice Address - Street 1:12300 SOUTHSHORE BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6237
Practice Address - Country:US
Practice Address - Phone:561-204-4494
Practice Address - Fax:561-204-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty