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NPI Code Detail

MEDICARE: CHILDREN AND TEEN DENTAL GROUP OF FLORIDA

MEDICARE: CHILDREN AND TEEN DENTAL GROUP OF FLORIDA
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
1122300000XDentist
21223S0112XOral and Maxillofacial Surgery (Dentist)
31223G0001XGeneral Practice Dentistry
41223P0221XPediatric Dentistry

General Provider Information

NPI Number : 1982072633
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN AND TEEN DENTAL GROUP OF FLORIDA
Provider Business Mailing Address
First Line : 2300 LAKEVIEW PKWY STE 250
Second Line :
City : ALPHARETTA
State : GA
Zip : 30009-3954
Country : US
Telephone Number : 470-207-3264
Fax Number :
Provider Business Practice Location Address
First Line : 225 IMPERIAL BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33803-4612
Country : US
Telephone Number : 863-644-4739
Fax Number :
Authorized Official
Title or Position : CFO
Name : BRIAN SMITH
Credential :
Telephone Number : 770-231-5348
Provider Enumeration Date : 09/11/2015
Last Update Date : 05/20/2026

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