Healthcare Provider Details

I. General information

NPI: 1003732223
Provider Name (Legal Business Name): ADVENTURE SMILES CHILDREN'S DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30193 WESLEY CHAPEL BLVD
WESLEY CHAPEL FL
33543
US

IV. Provider business mailing address

30193 WESLEY CHAPEL BLVD
WESLEY CHAPEL FL
33543
US

V. Phone/Fax

Practice location:
  • Phone: 813-579-8492
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NELLIE LIN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 813-579-8492