Healthcare Provider Details

I. General information

NPI: 1437460060
Provider Name (Legal Business Name): A WINNING SMILE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 FOREST HILL BLVD SUITE 114
WEST PALM BEACH FL
33415-7469
US

IV. Provider business mailing address

4623 FOREST HILL BLVD SUITE 114
WEST PALM BEACH FL
33415-7469
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-7000
  • Fax:
Mailing address:
  • Phone: 561-965-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN0011362
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberBM9991313
License Number StateFL

VIII. Authorized Official

Name: SABRINA SCHWARTZ
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 561-965-7000