Organization
PALM BEACH GARDENS ORTHO LOCATION LLC
Active
Organization
PALM BEACH GARDENS ORTHO LOCATION LLC
Active
Parent organization
CHARLESTON ORTHODONTIC SPECIALISTS, INC
Other names
The Smile Store
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHARLESTON ORTHODONTIC SPECIALISTS, INC
Authorized official
MRS. BRENDA COOPER (INSURANCE COORDINATOR)
(561) 658-4100
Entity
Organization
Contact information
Practice address
4362 NORTHLAKE BLVD STE 114, PALM BEACH GARDENS, FL 33410-6269
(561) 658-4100
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
Enumeration date
12/19/2019
Last updated
06/02/2021
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