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General NPI Number Information
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NPI Number | 1437013851
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Entity Type | Organization
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Legal Business Name | RADIANT SMILES PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 6519 STADIUM DR
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542-7567
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Country | US
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Telephone | 813-328-3122
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Fax | 813-328-3072
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Provider Business Mailing Address
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Address Line | 6519 STADIUM DR
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542-7567
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Country | US
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Telephone | 813-328-3122
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Fax | 813-328-3072
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN CLEOPHAS JOHNSON
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Credential | D.M.D.
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Telephone | 813-328-3122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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