Healthcare Provider Details

I. General information

NPI: 1851395883
Provider Name (Legal Business Name): SMILE PERFECT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 MIDDLE RIVER DR STE 501
FT LAUDERDALE FL
33304-3561
US

IV. Provider business mailing address

915 MIDDLE RIVER DR STE 501
FT LAUDERDALE FL
33304-3561
US

V. Phone/Fax

Practice location:
  • Phone: 954-566-0751
  • Fax: 954-566-1674
Mailing address:
  • Phone: 954-566-0751
  • Fax: 954-566-1674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberFL9534
License Number StateFL

VIII. Authorized Official

Name: DR. WILLIAM L BALANOFF
Title or Position: OWNER/DENTIST/PRESIDENT
Credential: DDS
Phone: 954-566-0754