Organization
KIDS SMILES DENTAL, PLLC
Active
Parent organization
KIDS SMILES PARTNERS, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
KIDS SMILES PARTNERS, PLLC
Authorized official
MRS. NEELY JORDAN (DIRECTOR OF OPERATIONS)
(813) 968-2483
Entity
Organization
Contact information
Practice address
1773 W FLETCHER AVE, TAMPA, FL 33612
(813) 968-2483
Mailing address
1773 W FLETCHER AVE, TAMPA, FL 33612-1820
(813) 968-2483
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN13285
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017306300
—
FL
05
—
075109000
—
FL
Enumeration date
10/27/2016
Last updated
07/23/2018
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