MEDICARE: KEEP SMILING BRACES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center		FL

General Provider Information

NPI Number	:	1467683631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEEP SMILING BRACES, LLC

Provider Business Mailing Address
First Line	:	3411 TAMIAMI TRL N
Second Line	:	SUITE 200
City	:	NAPLES
State	:	FL
Zip	:	34103-3700
Country	:	US
Telephone Number	:	239-300-6598
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 TAMIAMI TRL N
Second Line	:	SUITE 200
City	:	NAPLES
State	:	FL
Zip	:	34103-3700
Country	:	US
Telephone Number	:	850-264-7135
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. DEBORAH O LUX
Credential	:	D.D.S.
Telephone Number	:	239-300-6598

Provider Enumeration Date	:	08/05/2009
Last Update Date	:	06/16/2015

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