Healthcare Provider Details

I. General information

NPI: 1164227377
Provider Name (Legal Business Name): COOL SMILEZ OF HIALEAH FLORIDA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 W 20TH AVE STE 103
HIALEAH FL
33016-5509
US

IV. Provider business mailing address

7150 W 20TH AVE STE 103
HIALEAH FL
33016-5509
US

V. Phone/Fax

Practice location:
  • Phone: 786-600-0494
  • Fax: 786-592-0494
Mailing address:
  • Phone: 786-600-0494
  • Fax: 786-592-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
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 TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANDREW M DEMOS
Title or Position: PRESIDENT
Credential: DMD
Phone: 786-600-0494