Provider Demographics
NPI:1578312302
Name:SMILE INNOVATIONS DENTISTRY CORP
Entity type:Organization
Organization Name:SMILE INNOVATIONS DENTISTRY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YAMILE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAVICENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-233-4531
Mailing Address - Street 1:3833 CLEVELAND AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8663
Mailing Address - Country:US
Mailing Address - Phone:239-935-7704
Mailing Address - Fax:239-935-7709
Practice Address - Street 1:3833 CLEVELAND AVE STE 170
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8663
Practice Address - Country:US
Practice Address - Phone:239-935-7704
Practice Address - Fax:239-935-7709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty