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General NPI Number Information
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NPI Number | 1164227377
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Entity Type | Organization
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Legal Business Name | COOL SMILEZ OF HIALEAH FLORIDA, PLLC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 7150 W 20TH AVE STE 103
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City | HIALEAH
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State | FL
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Zip | 33016-5509
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Country | US
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Telephone | 786-600-0494
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Fax | 786-592-0494
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Provider Business Mailing Address
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Address Line | 7150 W 20TH AVE STE 103
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City | HIALEAH
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State | FL
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Zip | 33016-5509
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Country | US
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Telephone | 786-600-0494
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Fax | 786-592-0494
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW M DEMOS
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Credential | DMD
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Telephone | 786-600-0494
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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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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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