Healthcare Provider Details

I. General information

NPI: 1750633673
Provider Name (Legal Business Name): I SMILE SIGNATURE DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E BAY DR SUITE 1
LARGO FL
33771-5616
US

IV. Provider business mailing address

1601 E BAY DR SUITE 1
LARGO FL
33771-5616
US

V. Phone/Fax

Practice location:
  • Phone: 727-585-5675
  • Fax: 727-588-0114
Mailing address:
  • Phone: 727-585-5675
  • Fax: 727-588-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN18338
License Number StateFL

VIII. Authorized Official

Name: DR. SHAMSIA SHAFI
Title or Position: DENTIST
Credential: D.D.S.
Phone: 919-412-1251