Healthcare Provider Details

I. General information

NPI: 1588642078
Provider Name (Legal Business Name): MARIA V SMITH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11030 N KENDALL DR SUITE 202
MIAMI FL
33176-1220
US

IV. Provider business mailing address

11030 N KENDALL DR
MIAMI FL
33176-1220
US

V. Phone/Fax

Practice location:
  • Phone: 305-412-7202
  • Fax: 305-412-7203
Mailing address:
  • Phone: 305-412-7202
  • Fax: 305-412-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN11882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: