Healthcare Provider Details

I. General information

NPI: 1790448827
Provider Name (Legal Business Name): SMILE EVERYDAY DAVIE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 DAVIE RD SUITE 104,105,106
DAVIE FL
33314-3636
US

IV. Provider business mailing address

10450 N CAMELOT CIR
DAVIE FL
33328-2257
US

V. Phone/Fax

Practice location:
  • Phone: 954-680-8000
  • Fax: 954-320-6287
Mailing address:
  • Phone: 954-682-8000
  • Fax: 954-320-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANEL MORALES
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 954-682-8000