Healthcare Provider Details

I. General information

NPI: 1184533820
Provider Name (Legal Business Name): SMILE ADVENTURES PEDIATRIC DENTISTRY AND ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W HWY 50
CLERMONT FL
34711-2864
US

IV. Provider business mailing address

1020 W HWY 50
CLERMONT FL
34711-2864
US

V. Phone/Fax

Practice location:
  • Phone: 813-579-8492
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NELLIE LIN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 813-579-8492