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General NPI Number Information
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NPI Number | 1407215965
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Entity Type | Organization
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Legal Business Name | SMILES KINGDOM INC
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 3751 CLYDE MORRIS BLVD UNIT 7
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City | PORT ORANGE
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State | FL
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Zip | 32129-2356
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Country | US
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Telephone | 386-310-3060
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Fax | 386-872-5021
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Provider Business Mailing Address
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Address Line | 3751 CLYDE MORRIS BLVD UNIT 7
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City | PORT ORANGE
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State | FL
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Zip | 32129-2356
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Country | US
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Telephone | 386-310-3060
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Fax | 386-872-5021
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Authorized Official
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Title or Position | DENTIST
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Name | DR. STEVE D TABORDA
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Credential | DMD
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Telephone | 386-299-5625
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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 | DN21034
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN19830
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License Number State | FL
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