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General NPI Number Information
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NPI Number | 1659616233
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Entity Type | Organization
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Legal Business Name | LITTLE SMILES DENTAL OFFICE #2
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 10205 SOUTH DIXIE HIGHWAY SUITE 200/201
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City | PINECREST
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State | FL
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Zip | 33156
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Country | US
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Telephone | 305-279-4312
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Fax | 305-596-6632
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Provider Business Mailing Address
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Address Line | 10205 SOUTH DIXIE HIGHWAY SUITE 200/201
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City | PINECREST
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State | FL
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Zip | 33156
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Country | US
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Telephone | 305-279-4312
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Fax | 305-596-6632
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Authorized Official
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Title or Position | DR OWNER
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Name | MR. BAYARDO CORTES
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Credential | DMD.
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Telephone | 305-279-4312
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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 | DN15894
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License Number State | FL
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