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General NPI Number Information
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NPI Number | 1760755169
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Entity Type | Organization
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Legal Business Name | SMILING CREATIONS, PA
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 708 SPRING ST
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-3318
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Country | US
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Telephone | 904-284-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 708 SPRING ST
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-3318
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Country | US
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Telephone | 904-284-6688
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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 | DR. LARRY JAMES SMALL
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Credential | DMD
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Telephone | 904-284-6688
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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 | DN0010981
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License Number State | FL
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