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General NPI Number Information
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NPI Number | 1013278423
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Entity Type | Organization
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Legal Business Name | BRANDON SMILES
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 926 LUMSDEN RD.
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City | BRANDON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 813-438-8728
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Fax | 813-438-8730
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Provider Business Mailing Address
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Address Line | 926 LUMSDEN RD.
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City | BRANDON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 813-438-8728
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Fax | 813-438-8730
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Authorized Official
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Title or Position | OWNER
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Name | DR. VINCENT A. DELLE-DONNE
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Credential | DMD
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Telephone | 813-438-8728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN17083
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License Number State | FL
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