Organization
HAPPY SMILES OF PORT SAINT LUCIE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMON LEIZGOLD (OPERATIONS MANAGER)
(772) 807-1451
Entity
Organization
Contact information
Practice address
1100 SW ST LUCIE BLVD, 206, PORT SAINT LUCIE, FL 34986-1780
(772) 807-1451
Mailing address
1100 SW SAINT LUCIE BLVD, 206, PORT SAINT LUCIE, FL 34986
(772) 807-1451
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN16481
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000800101
—
FL
Enumeration date
03/04/2016
Last updated
03/04/2016
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