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General NPI Number Information
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NPI Number | 1184486854
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Entity Type | Organization
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Legal Business Name | THE SMILE MISSION OCALA PLLC
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 4901 E SILVER SPRINGS BLVD STE 600-601
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City | OCALA
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State | FL
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Zip | 34470-3228
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Country | US
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Telephone | 786-701-8246
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Fax |
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Provider Business Mailing Address
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Address Line | 9900 SW 168TH ST
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City | MIAMI
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State | FL
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Zip | 33157-4378
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DUSTIN PFUNDHELLER
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Credential |
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Telephone | 786-701-8246
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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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