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General NPI Number Information
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NPI Number | 1447585328
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Entity Type | Organization
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Legal Business Name | BEAUTFUL SMILES PEDIATRICS
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 10/09/2009
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Provider Practice Location Address
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Address Line | 5537 W OAKLAND PARK BLVD SUITE B
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City | LAUDERHILL
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State | FL
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Zip | 33313
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Country | US
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Telephone | 954-739-9577
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Fax | 954-739-9616
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Provider Business Mailing Address
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Address Line | 5537 W OAKLAND PARK BLVD SUITE B
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City | LAUDERHILL
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State | FL
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Zip | 33313-1411
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Country | US
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Telephone | 954-739-9577
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Fax | 954-739-9616
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Authorized Official
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Title or Position | OWNER
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Name | RONIA BAKER
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Credential | D.M.D
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Telephone | 954-739-9577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN-16129
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License Number State | FL
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