MEDICARE: SAILFISH SMILES, 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1801673868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAILFISH SMILES, PLLC

Provider Business Mailing Address
First Line	:	700 W GRANADA BLVD STE 100
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5194
Country	:	US
Telephone Number	:	914-879-9558
Fax Number	:

Provider Business Practice Location Address
First Line	:	2614 SE WILLOUGHBY BLVD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-4700
Country	:	US
Telephone Number	:	914-879-9558
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIELLE SOPHIA GUERRINO
Credential	:	DMD
Telephone Number	:	914-879-9558

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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