Healthcare Provider Details

I. General information

NPI: 1750158879
Provider Name (Legal Business Name): SMILE SO BIG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7586 SW 61ST AVE
OCALA FL
34476-8310
US

IV. Provider business mailing address

2112 SW 34TH ST # 418
GAINESVILLE FL
32608-1204
US

V. Phone/Fax

Practice location:
  • Phone: 352-484-0262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN AALONA MONTOYA
Title or Position: OWNER
Credential: DDS
Phone: 919-321-7824