Organization
FORTUNE SMILES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MADELENE MICHELLE TRUJILLO DDS (OWNER)
(305) 264-0747
Entity
Organization
Contact information
Practice address
18543 S DIXIE HWY, CUTLER BAY, FL 33157-6845
(305) 259-9210
(305) 259-9120
Mailing address
18543 SOUTH DIXIE HWY, CUTLER BAY, FL 33157-1765
(305) 264-0747
(305) 264-0595
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN18770
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013776
—
FL
Enumeration date
02/22/2010
Last updated
11/20/2015
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