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General NPI Number Information
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NPI Number | 1629458583
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Entity Type | Organization
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Legal Business Name | DENTAL SMILE THERAPY, PA
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 06/05/2015
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Provider Practice Location Address
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Address Line | 1901 N FEDERAL HWY UNIT 215
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City | POMPANO BEACH
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State | FL
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Zip | 33062-1000
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Country | US
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Telephone | 954-785-1102
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 N. FEDERAL HIGHWAY UNIT 215
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City | POMPANO BEACH
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State | FL
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Zip | 33062
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Country | US
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Telephone | 954-785-1102
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | RAFAELLA CORREA-PINTO
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Credential |
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Telephone | 954-785-1102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN18323
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN19480
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License Number State | FL
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