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General NPI Number Information
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NPI Number | 1043475437
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL SMILE INSTITUTE PA
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 2161 E COMMERCIAL BLVD 3RD FLOOR
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308
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Country | US
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Telephone | 954-772-0842
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Fax | 954-776-7480
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Provider Business Mailing Address
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Address Line | 2161 E COMMERCIAL BLVD 3RD FLOOR
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308
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Country | US
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Telephone | 954-772-0842
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Fax | 954-776-7480
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Authorized Official
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Title or Position | DENTIST PRESIDENT
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Name | STUART MICHAEL GOFF
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Credential | DDS
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Telephone | 954-772-0842
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN16553
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License Number State | FL
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