Provider Demographics
NPI:1023655057
Name:SMILE DENTAL WELLNESS
Entity type:Organization
Organization Name:SMILE DENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:INES
Authorized Official - Middle Name:M
Authorized Official - Last Name:ACARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-724-4813
Mailing Address - Street 1:TORRE DEL METROPOLITANO
Mailing Address - Street 2:SUITE 203 STATE ROAD 21 NUMBER 1789 LAS LOMAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-724-4813
Mailing Address - Fax:
Practice Address - Street 1:TORRE DEL METROPOLITANO
Practice Address - Street 2:SUITE 203 STATE ROAD 21 NUMBER 1789 LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-724-4813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty