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General NPI Number Information
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NPI Number | 1750981452
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Entity Type | Organization
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Legal Business Name | SMILLIE DENTAL PLLC
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 5537 S WILLIAMSON BLVD STE 675
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City | PORT ORANGE
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State | FL
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Zip | 32128-8314
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Country | US
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Telephone | 386-317-4754
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Fax |
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Provider Business Mailing Address
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Address Line | 5537 S WILLIAMSON BLVD STE 675
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City | PORT ORANGE
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State | FL
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Zip | 32128-8314
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Country | US
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Telephone | 386-317-4754
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | JOSEPH SMILLIE
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Credential | DMD
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Telephone | 321-446-9037
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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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