Healthcare Provider Details

I. General information

NPI: 1023774668
Provider Name (Legal Business Name): DENTA SMILES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CORAL RIDGE DR
CORAL SPRINGS FL
33071-4180
US

IV. Provider business mailing address

833 CORAL RIDGE DR
CORAL SPRINGS FL
33071-4180
US

V. Phone/Fax

Practice location:
  • Phone: 954-755-1222
  • Fax:
Mailing address:
  • Phone: 954-755-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: NICOLE FREYTES
Title or Position: DENTIST
Credential: DMD
Phone: 954-755-1222