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General NPI Number Information
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NPI Number | 1295398881
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Entity Type | Organization
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Legal Business Name | JUNIOR SMILES LLC
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Dates
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Enumeration Date | 04/18/2019
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Last Update Date | 04/18/2019
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Provider Practice Location Address
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Address Line | 8223 W ATLANTIC BLVD
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City | CORAL SPRINGS
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State | FL
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Zip | 33071
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Country | US
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Telephone | 954-507-0015
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Fax |
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Provider Business Mailing Address
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Address Line | 4183 NW 56TH ST
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City | COCONUT CREEK
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State | FL
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Zip | 33073
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Country | US
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Telephone | 860-515-8433
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PEDIATRIC DENTIST
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Name | TIFFANY A BRADY
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Credential | DMD
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Telephone | 860-839-5228
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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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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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