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General NPI Number Information
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NPI Number | 1952063596
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Entity Type | Organization
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Legal Business Name | SERENITY SMILES
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 28441 S TAMIAMI TRL
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-3212
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Country | US
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Telephone | 239-317-0014
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Fax |
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Provider Business Mailing Address
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Address Line | 17339 MEADOW LAKE CIR
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City | FORT MYERS
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State | FL
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Zip | 33967-2546
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Country | US
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Telephone | 305-890-5372
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ERNESTO LLERENA
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Credential | DMD
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Telephone | 305-890-5372
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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 |
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License Number State |
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