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General NPI Number Information
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NPI Number | 1861851115
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Entity Type | Organization
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Legal Business Name | SMILE DESIGN OF HALLANDALE BEACH LLC
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 2100 E HALLANDALE BEACH BLVD STE 305
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-3765
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Country | US
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Telephone | 954-454-4949
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Fax | 954-454-4940
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Provider Business Mailing Address
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Address Line | 2100 E HALLANDALE BEACH BLVD STE 305
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-3765
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Country | US
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Telephone | 954-454-4949
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Fax | 954-454-4940
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Authorized Official
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Title or Position | PRES
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Name | DR. NATHALIE VERA
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Credential | DMD
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Telephone | 954-454-4949
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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 | DN18962
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License Number State | FL
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