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General NPI Number Information
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NPI Number | 1265388987
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Entity Type | Organization
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Legal Business Name | SMILE DESIGN EAGLE CREEK LLC
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 12692 TAMIAMI TRL E
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City | NAPLES
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State | FL
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Zip | 34113-8431
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Country | US
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Telephone | 239-417-6453
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Fax | 239-203-2355
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Provider Business Mailing Address
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Address Line | 12692 TAMIAMI TRL E
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City | NAPLES
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State | FL
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Zip | 34113-8431
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Country | US
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Telephone | 239-417-6453
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Fax | 239-203-2355
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JULI RENEE MIETZNER
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Credential |
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Telephone | 217-540-5651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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