Provider Demographics
NPI:1649010513
Name:M & R GENTLE SMILE
Entity type:Organization
Organization Name:M & R GENTLE SMILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISOLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-804-3011
Mailing Address - Street 1:9112 W STATE ROAD 84 # C09
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4416
Mailing Address - Country:US
Mailing Address - Phone:305-804-3011
Mailing Address - Fax:
Practice Address - Street 1:9112 W STATE ROAD 84 # C09
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4416
Practice Address - Country:US
Practice Address - Phone:305-804-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental