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General NPI Number Information
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NPI Number | 1730897240
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Entity Type | Organization
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Legal Business Name | EVENLY SOUTHEAST, PLLC
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 8223 W ATLANTIC BLVD
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-7450
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Country | US
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Telephone | 800-500-0493
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Fax |
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Provider Business Mailing Address
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Address Line | 7250 WOODMONT AVE STE 330
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City | BETHESDA
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State | MD
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Zip | 20814-3057
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Country | US
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Telephone | 800-500-0493
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED MEMBER/ORTHODONTIST
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Name | DR. SHAUN SMITH
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Credential | DDS
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Telephone | 240-394-0567
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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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