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Organization
SMILE DENTAL PLLC
Active
Organization
SMILE DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTA ANDISCO (MANAGER)
(239) 319-2440
Entity
Organization
Contact information
Practice address
9500 BONITA BEACH RD SE STE 301, BONITA SPRINGS, FL 34135-4698
(239) 319-2440
Mailing address
9491 CEDAR CREEK DR, BONITA SPRINGS, FL 34135-7517
(954) 649-5588
(954) 649-5588
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114280245
NPI
—
01
—
1326298753
NPI
FL
Enumeration date
11/28/2017
Last updated
11/28/2017
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