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General NPI Number Information
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NPI Number | 1134901820
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Entity Type | Organization
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Legal Business Name | TAMARAC SMILE CENTER
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 6510 N UNIVERSITY DR
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City | TAMARAC
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State | FL
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Zip | 33321-4001
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Country | US
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Telephone | 954-417-4499
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Fax | 954-210-8074
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Provider Business Mailing Address
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Address Line | 6510 N UNIVERSITY DR
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City | TAMARAC
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State | FL
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Zip | 33321-4001
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Country | US
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Telephone | 954-417-4499
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Fax | 954-210-8074
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Authorized Official
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Title or Position | PRESIDENT
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Name | BLANCA CASTELLO
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Credential |
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Telephone | 954-850-4367
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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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