Provider Demographics
NPI:1750981452
Name:SMILLIE DENTAL PLLC
Entity type:Organization
Organization Name:SMILLIE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SMILLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-446-9037
Mailing Address - Street 1:5537 S WILLIAMSON BLVD STE 675
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-8314
Mailing Address - Country:US
Mailing Address - Phone:386-317-4754
Mailing Address - Fax:
Practice Address - Street 1:5537 S WILLIAMSON BLVD STE 675
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-8314
Practice Address - Country:US
Practice Address - Phone:386-317-4754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental