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General NPI Number Information
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NPI Number | 1639514045
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Entity Type | Organization
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Legal Business Name | SMILE DESIGN STUDIO INC
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 1331 S INTERNATIONAL PKWY SUITE 2271
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City | LAKE MARY
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State | FL
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Zip | 32746-1405
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Country | US
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Telephone | 407-804-0770
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Fax | 407-804-0773
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Provider Business Mailing Address
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Address Line | 1331 S INTERNATIONAL PKWY SUITE 2271
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City | LAKE MARY
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State | FL
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Zip | 32746-1405
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Country | US
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Telephone | 407-804-0770
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Fax | 407-804-0773
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK A FALCO
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Credential | DMD, MS
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Telephone | 407-804-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN12688
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License Number State | FL
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