Organization
BRANDON SMILES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ATHANASIOS KOKKAS DDS (MANAGER)
(205) 999-9527
Entity
Organization
Contact information
Practice address
926 WEST LUMSDEN RD, BRANDON, FL 33511
(813) 438-8728
(813) 438-8730
Mailing address
926 WEST LUMSDEN RD, BRANDON, FL 33511
(813) 438-8728
(813) 438-8730
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN16761
FL
1223G0001X
General Practice Dentistry
DN16761
FL
Other
Enumeration date
11/09/2017
Last updated
11/09/2017
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