Provider Demographics
NPI:1992263255
Name:DELRAY SMILES FAMILY DENTISTRY AND ORTHODONTICS, PA
Entity type:Organization
Organization Name:DELRAY SMILES FAMILY DENTISTRY AND ORTHODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-817-3703
Mailing Address - Street 1:15084 LYONS ROAD
Mailing Address - Street 2:SUITE #600
Mailing Address - City:DELRAY
Mailing Address - State:FL
Mailing Address - Zip Code:33446
Mailing Address - Country:US
Mailing Address - Phone:305-992-8829
Mailing Address - Fax:
Practice Address - Street 1:15084 LYONS ROAD
Practice Address - Street 2:SUITE #600
Practice Address - City:DELRAY
Practice Address - State:FL
Practice Address - Zip Code:33446
Practice Address - Country:US
Practice Address - Phone:305-992-8829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDREA TRUJILLO DMD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty