MEDICARE: DRSMILE INC.

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	10129	FL

General Provider Information

NPI Number	:	1821105529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRSMILE INC.

Provider Business Mailing Address
First Line	:	7351 W OAKLAND PARK BLVD
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-7107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7351 W OAKLAND PARK BLVD
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-7107
Country	:	US
Telephone Number	:	954-742-5055
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PHILIP PINE
Credential	:
Telephone Number	:	954-742-5055

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	08/22/2020

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Directions to “DRSMILE INC. ” Practice Location

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