Organization
THE SMILE STORE-PALM BEACH GARDENS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS J. SAVASTANO JR. DMD, MS (OWNER/DOCTOR)
(561) 658-4100
Entity
Organization
Contact information
Practice address
4362 NORTHLAKE BLVD STE 114, PALM BEACH GARDENS, FL 33410-6269
(561) 658-4100
(866) 333-2309
Mailing address
4362 NORTHLAKE BLVD STE 114, PALM BEACH GARDENS, FL 33410-6269
(561) 658-4100
(866) 333-2309
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105737100
—
FL
01
—
1154348233
TYPE 1 NPI PROVIDER ID DR. SAVASTANO
FL
01
—
1518505692
NPI 2 OF OLD TIN/LLC NAME FOR SAME DOCTOR, SAME LOCATION
FL
01
—
DN15487
DENTAL LICENSE
FL
Enumeration date
03/04/2022
Last updated
03/04/2022
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