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General NPI Number Information
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NPI Number | 1366227654
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Entity Type | Organization
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Legal Business Name | SMILE MISSION SARASOTA PLLC
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 11525 STATE ROAD 70 E UNIT 11525
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-9419
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Country | US
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Telephone | 786-701-8246
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Fax |
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Provider Business Mailing Address
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Address Line | 9900 SW 168TH ST
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City | MIAMI
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State | FL
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Zip | 33157-4378
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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 | MANAGER
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Name | DUSTIN PFUNDHELLER
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Credential | DMD
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Telephone | 786-701-8246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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