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General NPI Number Information
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NPI Number | 1205554300
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILES DENTAL OF PORT SAINT LUCIE FL PLLC
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 258 SW PORT ST LUCIE BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-5044
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Country | US
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Telephone | 772-877-0488
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Fax | 772-877-0814
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Provider Business Mailing Address
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Address Line | 8495 TWIN LAKE DR
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City | BOCA RATON
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State | FL
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Zip | 33496-1923
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Country | US
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Telephone | 954-397-1452
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACQUES BENCHIMOL
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Credential | DMD
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Telephone | 954-397-1452
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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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