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General NPI Number Information
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NPI Number | 1669335212
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Entity Type | Organization
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Legal Business Name | GREAT SMILE DENTAL PEDIATRICS
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 155 SW PORT ST LUCIE BLVD STE 105
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City | PORT ST LUCIE
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State | FL
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Zip | 34984-5039
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Country | US
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Telephone | 772-398-0990
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Fax | 772-800-3634
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Provider Business Mailing Address
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Address Line | 155 SW PORT ST LUCIE BLVD STE 105
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City | PORT ST LUCIE
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State | FL
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Zip | 34984-5039
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Country | US
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Telephone | 772-398-0990
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Fax | 772-800-3634
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Authorized Official
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Title or Position | OWNER
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Name | DR. AARON M SCHAMBACK
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Credential | DMD
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Telephone | 772-398-0990
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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 |
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License Number State |
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