MEDICARE: SMILES DENTAL PLLC

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	122300000X	Dentist	DN 15925	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366896938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILES DENTAL PLLC

Provider Business Mailing Address
First Line	:	700 W HILLSBORO BLVD STE 1-109
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-1613
Country	:	US
Telephone Number	:	754-264-7264
Fax Number	:	954-248-2484

Provider Business Practice Location Address
First Line	:	700 W HILLSBORO BLVD STE 1-109
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-1613
Country	:	US
Telephone Number	:	754-264-7264
Fax Number	:	954-248-2484

Authorized Official
Title or Position	:	OWNER/GENERAL DENTIST
Name	:	DR. SUNEETHA ATLURI
Credential	:	D.M.D
Telephone Number	:	754-264-7264

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	04/20/2016

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Directions to “SMILES DENTAL PLLC ” Practice Location

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