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General NPI Number Information
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NPI Number | 1134645864
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Entity Type | Organization
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Legal Business Name | WINTER SPRINGS SMILES DENTISTRY, PA
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 5908 RED BUG LAKE RD
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-5011
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Country | US
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Telephone | 407-439-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 17000 RED HILL AVE
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City | IRVINE
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State | CA
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Zip | 92614-5626
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Country | US
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Telephone | 714-845-8890
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Fax |
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Authorized Official
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Title or Position | DDS / OWNER
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Name | MINH B PHAM
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Credential |
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Telephone | 407-439-1230
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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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