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General NPI Number Information
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NPI Number | 1932308145
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Entity Type | Organization
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Legal Business Name | SMILE DESIGNS BY CHARLOTTE GERRY
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 857 SW MAIN BLVD SUITE 105
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City | LAKE CITY
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State | FL
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Zip | 32024
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Country | US
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Telephone | 386-755-7010
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Fax | 386-755-7024
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Provider Business Mailing Address
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Address Line | 857 SW MAIN BLVD SUITE 105
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City | LAKE CITY
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State | FL
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Zip | 32024
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Country | US
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Telephone | 386-755-7010
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Fax | 386-755-7024
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLOTTE GERRY
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Credential | DMD
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Telephone | 386-755-7010
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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 | DN14233
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License Number State | FL
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