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General NPI Number Information
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NPI Number | 1730795857
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Entity Type | Organization
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Legal Business Name | KIND SMILES DENTAL HEALTH
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 11155 STATE ROAD 70 E
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202
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Country | US
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Telephone | 941-253-5565
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Fax | 813-336-0836
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Provider Business Mailing Address
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Address Line | 11155 STATE ROAD 70 EAST
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-8264
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Country | US
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Telephone | 941-251-6225
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Fax |
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Authorized Official
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Title or Position | AO
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Name | ALLISON KONICK
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Credential |
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Telephone | 941-251-6225
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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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