Healthcare Provider Details

I. General information

NPI: 1336754902
Provider Name (Legal Business Name): LHA SMILES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6704 HANLEY RD
TAMPA FL
33634-4743
US

IV. Provider business mailing address

6704 HANLEY RD
TAMPA FL
33634-4743
US

V. Phone/Fax

Practice location:
  • Phone: 813-284-7903
  • Fax:
Mailing address:
  • Phone: 786-427-7059
  • 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: LUIS HERNANDEZ ABREU
Title or Position: DENTIST
Credential: DMD
Phone: 786-427-7059