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General NPI Number Information
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NPI Number | 1730891136
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Entity Type | Organization
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Legal Business Name | CLEAR SMILES HOLDINGS LLC
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Dates
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Enumeration Date | 12/16/2022
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 1261 S FEDERAL HWY
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City | POMPANO BEACH
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State | FL
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Zip | 33062-7070
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Country | US
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Telephone | 754-225-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 12169 PEMBROKE RD
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-1727
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Country | US
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Telephone | 954-505-3269
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Fax | 954-589-0810
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Authorized Official
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Title or Position | COO
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Name | DANIEL RODRIGUEZ
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Credential |
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Telephone | 954-505-3269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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