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General NPI Number Information
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NPI Number | 1912355660
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Entity Type | Organization
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Legal Business Name | CELEBRITY SMILES MELBOURNE
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 2575 W NEW HAVEN AVE
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-3701
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Country | US
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Telephone | 321-914-0929
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Fax |
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Provider Business Mailing Address
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Address Line | 2575 W NEW HAVEN AVE
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-3701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. ANAND SHAH
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Credential | DMD
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Telephone | 321-914-0929
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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 | DN 19903
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License Number State | FL
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