Organization
CHILDREN AND TEEN DENTAL GROUP OF FLORIDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN SMITH (CFO)
(770) 231-5348
Entity
Organization
Contact information
Practice address
225 IMPERIAL BLVD, LAKELAND, FL 33803-4612
(863) 644-4739
Mailing address
2300 LAKEVIEW PKWY STE 250, ALPHARETTA, GA 30009-3954
(470) 207-3264
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
09/11/2015
Last updated
01/21/2025
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