MEDICARE: ADVENTURE SMILES CHILDREN'S DENTISTRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1003732223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVENTURE SMILES CHILDREN'S DENTISTRY LLC

Provider Business Mailing Address
First Line	:	30193 WESLEY CHAPEL BLVD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30193 WESLEY CHAPEL BLVD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543
Country	:	US
Telephone Number	:	813-579-8492
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	NELLIE LIN
Credential	:
Telephone Number	:	813-579-8492

Provider Enumeration Date	:	06/24/2026
Last Update Date	:	06/24/2026

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