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General NPI Number Information
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NPI Number | 1891512844
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Entity Type | Organization
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Legal Business Name | FANCY SMILES DENTAL STUDIO
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Dates
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Enumeration Date | 09/23/2024
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 1301 N CONGRESS AVE STE 110
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-3360
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Country | US
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Telephone | 561-873-2629
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Fax |
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Provider Business Mailing Address
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Address Line | 4857 FOXWOOD CIR
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-1119
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Country | US
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Telephone | 561-801-6869
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FRANCESCA SCARLETT
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Credential | DDS
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Telephone | 561-801-6869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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