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General NPI Number Information
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NPI Number | 1316016322
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Entity Type | Organization
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Legal Business Name | SMILE CENTRE PA
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 5899 WHITFIELD AVE STE 105
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City | SARASOTA
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State | FL
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Zip | 34243-3127
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Country | US
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Telephone | 941-351-4468
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Fax | 941-351-9361
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Provider Business Mailing Address
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Address Line | 5899 WHITFIELD AVE SUITE 105
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City | SARASOTA
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State | FL
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Zip | 34243-6152
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Country | US
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Telephone | 941-351-4468
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Fax | 941-351-9361
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. TRICIA LEIGH STANLEY
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Credential |
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Telephone | 941-351-4468
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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 | DN12608
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN16079
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH6360
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH15541
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN10983
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License Number State | FL
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