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General NPI Number Information
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NPI Number | 1154608370
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Entity Type | Organization
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Legal Business Name | LITTLE SMILES DENTAL OFFICE #1
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 15495 EAGLE NEST LN STE 110
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2242
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Country | US
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Telephone | 305-698-7566
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Fax | 305-698-7565
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Provider Business Mailing Address
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Address Line | 15495 EAGLE NEST LN STE 110
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2242
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Country | US
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Telephone | 305-698-7566
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Fax | 305-698-7565
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. BAYARDO C CORTES
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Credential | DMD
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Telephone | 305-698-7566
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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 | DN15894
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License Number State | FL
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