Healthcare Provider Details

I. General information

NPI: 1063336964
Provider Name (Legal Business Name): THE SMILE MISSION NORTH MIAMI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11045 NW 7TH AVE
MIAMI FL
33168-2109
US

IV. Provider business mailing address

9900 SW 168TH ST STE 1
MIAMI FL
33157-4378
US

V. Phone/Fax

Practice location:
  • Phone: 786-701-8246
  • Fax:
Mailing address:
  • Phone: 786-701-8246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN PFUNDHELLER
Title or Position: MANAGER
Credential:
Phone: 786-701-8246