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General NPI Number Information
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NPI Number | 1114468394
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Entity Type | Organization
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Legal Business Name | SMILES BY DESIGN
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 1779 S PINELLAS AVE STE 100
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-1920
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Country | US
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Telephone | 727-940-6808
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Fax | 727-940-6669
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Provider Business Mailing Address
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Address Line | 1779 S PINELLAS AVE STE 100
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-1920
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Country | US
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Telephone | 727-940-6808
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Fax | 727-940-6669
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MICHAEL CHARLES SAMPSON
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Credential | D.M.D.
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Telephone | 727-940-6808
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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 | 8609
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License Number State | FL
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