Provider Demographics
NPI:1548094337
Name:SMILEVILLE DENTAL PLLC
Entity type:Organization
Organization Name:SMILEVILLE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SRIVIDYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VULUGUNDAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-294-8153
Mailing Address - Street 1:9319 MANGROVE CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26827 FOGGY CREEK RD STE 103
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6768
Practice Address - Country:US
Practice Address - Phone:813-994-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty