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General NPI Number Information
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NPI Number | 1558931204
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Entity Type | Organization
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Legal Business Name | SMILE PERFECTION DENTAL & BRACES OF ROYAL PALM BEACH PA
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 06/25/2021
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Provider Practice Location Address
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Address Line | 10399 SOUTHERN BLVD
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-4339
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Country | US
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Telephone | 561-204-1719
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Fax |
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Provider Business Mailing Address
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Address Line | 10399 SOUTHERN BLVD
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-4339
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Country | US
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Telephone | 954-203-0933
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RICARDO CHANG
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Credential | DDS
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Telephone | 561-204-1719
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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