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PALM BEACH GARDENS ORTHO LOCATION LLC NPI 1518505692


NPI Information

NPI: 1518505692
Provider Name: PALM BEACH GARDENS ORTHO LOCATION LLC

Doing Business As: THE SMILE STORE

Classification: Dentist - 1223X0400X
Entity Type: Organization

Specialization: Orthodontics and Dentofacial Orthopedics

Address:
4362 NORTHLAKE BLVD STE 114
PALM BEACH GARDENS, FL
ZIP 33410
Phone: (561) 658-4100
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PALM BEACH GARDENS ORTHO LOCATION LLC is an orthodontics and dentofacial orthopedics dentist in Palm Beach Gardens, FL. The provider is that area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. PALM BEACH GARDENS ORTHO LOCATION LLC NPI is 1518505692. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As The Smile Store.

The provider's business location address is:

4362 NORTHLAKE BLVD STE 114
PALM BEACH GARDENS, FL
ZIP 33410-269
Phone: (561) 658-4100

The provider's authorized official is Brenda Cooper .
The authorized official title is Insurance Coordinator and has the following contact phone number (561) 658-4100.

The enumeration date for this NPI number is 12/19/2019 and was last updated on 6/2/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223X0400XDentistOrthodontics and Dentofacial OrthopedicsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1105737100MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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