Provider Demographics
NPI:1144872029
Name:MY FOREVER SMILES LLC
Entity type:Organization
Organization Name:MY FOREVER SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BORRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-363-1904
Mailing Address - Street 1:7208 W SAND LAKE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5277
Mailing Address - Country:US
Mailing Address - Phone:407-363-1904
Mailing Address - Fax:407-577-3418
Practice Address - Street 1:7208 W SAND LAKE RD STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5277
Practice Address - Country:US
Practice Address - Phone:407-363-1904
Practice Address - Fax:407-577-3418
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY FOREVER SMILES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty