Organization
FORTUNE SMILES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MADELENE MICHELLE TRUJILLO DDS (DENTIST)
(305) 259-9120
Entity
Organization
Contact information
Practice address
2879 S UNIVERSITY DR, DAVIE, FL 33328-1440
(954) 474-2499
(954) 474-1966
Mailing address
2879 S UNIVERSITY DR, DAVIE, FL 33328-1440
(954) 474-2499
(954) 474-1966
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D18770
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013776
—
FL
Enumeration date
11/12/2015
Last updated
11/12/2015
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