Provider Demographics
NPI:1548865447
Name:BELLEAIR SMILES
Entity type:Organization
Organization Name:BELLEAIR SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CLEMENT
Authorized Official - Last Name:FERRARA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:727-386-5107
Mailing Address - Street 1:1180 PONCE DE LEON BLVD STE 801B
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1031
Mailing Address - Country:US
Mailing Address - Phone:727-386-5107
Mailing Address - Fax:727-386-5917
Practice Address - Street 1:1180 PONCE DE LEON BLVD STE 801B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-1031
Practice Address - Country:US
Practice Address - Phone:727-386-5107
Practice Address - Fax:727-386-5917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty