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General NPI Number Information
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NPI Number | 1538477633
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Entity Type | Organization
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Legal Business Name | PETIT SMILES, LLC
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 1535 SUNSET DR
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City | CORAL GABLES
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State | FL
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Zip | 33143-5878
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Country | US
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Telephone | 800-895-1570
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Fax | 800-928-3811
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Provider Business Mailing Address
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Address Line | 1535 SUNSET DR
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City | CORAL GABLES
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State | FL
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Zip | 33143-5878
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Country | US
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Telephone | 800-895-1570
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Fax | 800-928-3811
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Authorized Official
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Title or Position | PEDIATRIC DENTIST- OWNER
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Name | DR. CARLA VANESSA RUIZ
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Credential | D.D.S.
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Telephone | 786-417-7295
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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 | DN17056
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License Number State | FL
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