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General NPI Number Information
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NPI Number | 1750633673
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Entity Type | Organization
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Legal Business Name | I SMILE SIGNATURE DENTISTRY
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 1601 E BAY DR SUITE 1
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City | LARGO
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State | FL
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Zip | 33771-5616
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Country | US
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Telephone | 727-585-5675
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Fax | 727-588-0114
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Provider Business Mailing Address
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Address Line | 1601 E BAY DR SUITE 1
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City | LARGO
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State | FL
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Zip | 33771-5616
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Country | US
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Telephone | 727-585-5675
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Fax | 727-588-0114
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SHAMSIA SHAFI
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Credential | D.D.S.
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Telephone | 919-412-1251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN18338
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License Number State | FL
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