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General NPI Number Information
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NPI Number | 1932216454
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Entity Type | Organization
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Legal Business Name | SMILE GARDEN INC
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 6880 TAFT STREET
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City | HOLLYWOOD
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-987-4141
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Fax | 954-962-2484
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Provider Business Mailing Address
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Address Line | 6880 TAFT STREET
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City | HOLLYWOOD
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-987-4141
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Fax | 954-962-2484
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. ALYNE TENDERO
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Credential | DDS
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Telephone | 954-987-4141
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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 | DN15750
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License Number State | FL
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