Healthcare Provider Details

I. General information

NPI: 1538477633
Provider Name (Legal Business Name): PETIT SMILES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 SUNSET DR
CORAL GABLES FL
33143-5878
US

IV. Provider business mailing address

1535 SUNSET DR
CORAL GABLES FL
33143-5878
US

V. Phone/Fax

Practice location:
  • Phone: 800-895-1570
  • Fax: 800-928-3811
Mailing address:
  • Phone: 800-895-1570
  • Fax: 800-928-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN17056
License Number StateFL

VIII. Authorized Official

Name: DR. CARLA VANESSA RUIZ
Title or Position: PEDIATRIC DENTIST- OWNER
Credential: D.D.S.
Phone: 786-417-7295