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General NPI Number Information
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NPI Number | 1043189947
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Entity Type | Organization
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Legal Business Name | SMILE ISLE ORTHODONTICS PLLC
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Dates
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Enumeration Date | 10/30/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 14735 SULLY RUN
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City | ODESSA
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State | FL
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Zip | 33556-4674
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Country | US
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Telephone | 916-276-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 416 S PALOMA PL
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City | TAMPA
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State | FL
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Zip | 33609-3712
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. MARINA KOSTUROS
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Credential | DDS MSD
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Telephone | 916-276-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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