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General NPI Number Information
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NPI Number | 1306281910
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Entity Type | Organization
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Legal Business Name | YOUR BEAUTIFUL SMILE, LLC
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Dates
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Enumeration Date | 05/09/2013
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 10301 HAGEN RANCH RD SUITE C140
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3724
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Country | US
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Telephone | 561-737-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 10301 HAGEN RANCH RD SUITE C140
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3724
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL PARTNER
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Name | PETER SILBERSTEIN
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Credential |
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Telephone | 561-737-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN0010635
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License Number State | FL
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