Organization
LAKE MARY SMILES, PLLC
Active
Other names
Lake Mary Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
PETER KELLY (OWNER)
(407) 333-7393
Entity
Organization
Contact information
Practice address
570 RINEHART RD STE 110, LAKE MARY, FL 32746-4801
(407) 333-7393
Mailing address
3221 CONWAY RD STE D, ORLANDO, FL 32812-7354
(407) 432-6224
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DM19430
STATE LICENSE
FL
Enumeration date
03/24/2022
Last updated
03/24/2022
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