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Organization
LAUDERDALE ISMILE
Active
Organization
LAUDERDALE ISMILE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHEILA RONQUILLO (OFFICE MANAGER)
(786) 390-5716
Entity
Organization
Contact information
Practice address
2412 N STATE ROAD 7, LAUDERDALE LAKES, FL 33313-3724
(954) 281-7405
(954) 281-7572
Mailing address
2412 N STATE ROAD 7, LAUDERDALE LAKES, FL 33313-3724
(954) 281-7405
(954) 281-7572
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
03/05/2024
Last updated
02/18/2025
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