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General NPI Number Information
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NPI Number | 1689397796
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Entity Type | Organization
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Legal Business Name | CRISTAL PEDIATRIC SMILE
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 7737 N UNIVERSITY DR STE 100
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City | TAMARAC
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State | FL
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Zip | 33321-2968
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Country | US
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Telephone | 215-939-0849
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Fax |
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Provider Business Mailing Address
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Address Line | 7737 N UNIVERSITY DR STE 100
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City | TAMARAC
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State | FL
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Zip | 33321-2968
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Country | US
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Telephone | 215-939-0849
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTISTRY
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Name | DR. ALEJANDRA ROMERO
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Credential | DMD
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Telephone | 215-939-0849
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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 |
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License Number State |
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