Organization
JUNIOR SMILES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY A BRADY DMD (PRESIDENT/PEDIATRIC DENTIST)
(860) 839-5228
Entity
Organization
Contact information
Practice address
8223 W ATLANTIC BLVD, CORAL SPRINGS, FL 33071
(954) 507-0015
Mailing address
4183 NW 56TH ST, COCONUT CREEK, FL 33073
(860) 515-8433
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01544500
—
FL
Enumeration date
04/18/2019
Last updated
04/18/2019
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