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General NPI Number Information
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NPI Number | 1255775649
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Entity Type | Organization
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Legal Business Name | SIMPLY SMILE ORTHODONTICS OF PEMBROKE PINES, LLC
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 700 N HIATUS RD SUITE 101
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-5206
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Country | US
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Telephone | 954-973-5725
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Fax |
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Provider Business Mailing Address
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Address Line | 9291 GLADES RD SUITE 301
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City | BOCA RATON
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State | FL
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Zip | 33434-3959
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Country | US
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Telephone | 561-477-7171
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Fax | 561-477-7577
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Authorized Official
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Title or Position | OWNER
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Name | ERNEST ORPHANOS
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Credential | DDS
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Telephone | 561-477-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN17283
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License Number State | FL
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