=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801673868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAILFISH SMILES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2023
-----------------------------------------------------
Last Update Date | 09/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2614 SE WILLOUGHBY BLVD
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994-4700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-879-9558
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 W GRANADA BLVD STE 100
-----------------------------------------------------
City | ORMOND BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32174-5194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-879-9558
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANIELLE SOPHIA GUERRINO
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 914-879-9558
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------