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1295682284 NPI number — SMILE PLUS DENTAL GROUP INC

NPI Number: 1295682284
Health Care Provider/Practitioner: SMILE PLUS DENTAL GROUP INC

Information about “1295682284” NPI (SMILE PLUS DENTAL GROUP INC) exists in 1295682284 in HTML format HTML  |  1295682284 in plain Text format TXT  |  1295682284 in PDF (Portable Document Format) PDF  |  1295682284 in an XML format XML  formats.

NPI Number : 1295682284 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295682284",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SMILE PLUS DENTAL GROUP INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4200 W CYPRESS ST STE 690",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TAMPA",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33607-4112",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "813-690-0666",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1421 US HIGHWAY 98",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKELAND",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33801-6574",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "813-690-0666",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/11/2026",
    "LastUpdateDate": "03/11/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LUGO GONZALEZ",
    "AuthorizedOfficialFirstName": "VIVIENNE",
    "AuthorizedOfficialMiddleName": "MARIE",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DMD",
    "AuthorizedOfficialTelephoneNumber": "813-690-0666",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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