Healthcare Provider Details

I. General information

NPI: 1659094548
Provider Name (Legal Business Name): SANDY SMILES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 EGLIN PKWY NE
FORT WALTON BEACH FL
32547-2530
US

IV. Provider business mailing address

150 LATONKA DR
MERCER PA
16137-9360
US

V. Phone/Fax

Practice location:
  • Phone: 850-244-3880
  • Fax:
Mailing address:
  • Phone: 724-816-4548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MORGAN MARION ZWICKEL
Title or Position: OWNER
Credential: DMD
Phone: 724-816-4548