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General NPI Number Information
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NPI Number | 1104214865
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Entity Type | Organization
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Legal Business Name | SEA OF SMILES, INC.
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 3737 MARYWEATHER LN
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7779
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Country | US
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Telephone | 813-528-8717
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Fax | 813-528-8728
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Provider Business Mailing Address
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Address Line | 3737 MARYWEATHER LN
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7779
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Country | US
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Telephone | 813-528-8717
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Fax | 813-528-8728
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Authorized Official
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Title or Position | PEDIATRIC DENTIST/ OWNER
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Name | DR. LISA MARIE LAPRESTI
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Credential | D.M.D.
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Telephone | 813-528-8717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN14677
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN17430
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License Number State |
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