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General NPI Number Information
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NPI Number | 1982154340
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Entity Type | Organization
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Legal Business Name | DESTIN SMILES. PA
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 12273 US HIGHWAY 98 W SUITE 117
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-6963
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Country | US
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Telephone | 850-424-7887
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Fax |
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Provider Business Mailing Address
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Address Line | 12273 US HIGHWAY 98 W SUITE 117
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-6963
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Country | US
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Telephone | 850-424-7887
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. OLIVIER BROUTIN
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Credential | D.M.D., M.A.G.D.
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Telephone | 850-259-5611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN15111
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License Number State | FL
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