Healthcare Provider Details

I. General information

NPI: 1750068482
Provider Name (Legal Business Name): GREAT FLORIDA SMILES & ORTHODONTICS PBC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 THOMAS DR
PANAMA CITY BEACH FL
32408
US

IV. Provider business mailing address

900 THOMAS DR
PANAMA CITY BEACH FL
32408
US

V. Phone/Fax

Practice location:
  • Phone: 850-249-9311
  • Fax:
Mailing address:
  • Phone: 850-249-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL O'DONNELL
Title or Position: DOCTOR OWNER
Credential: DMD
Phone: 850-249-9311