=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437531290
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOMA SMILES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2015
-----------------------------------------------------
Last Update Date | 05/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3580 LAKE WORTH ROAD
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-425-5090
-----------------------------------------------------
Fax | 561-275-7177
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3580 LAKE WORTH ROAD
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-425-5090
-----------------------------------------------------
Fax | 561-275-7177
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RASMI AKEL
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 561-425-5090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN15799
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------