Provider Demographics
NPI:1447585328
Name:BEAUTFUL SMILES PEDIATRICS
Entity type:Organization
Organization Name:BEAUTFUL SMILES PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-739-9577
Mailing Address - Street 1:5537 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1411
Mailing Address - Country:US
Mailing Address - Phone:954-739-9577
Mailing Address - Fax:954-739-9616
Practice Address - Street 1:5537 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:954-739-9577
Practice Address - Fax:954-739-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-161291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty