Provider Demographics
NPI:1760209118
Name:SMILE OASIS AT SANFORD PA
Entity type:Organization
Organization Name:SMILE OASIS AT SANFORD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-202-7676
Mailing Address - Street 1:5030 W STATE ROAD 46 STE 1018
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9247
Mailing Address - Country:US
Mailing Address - Phone:407-792-0226
Mailing Address - Fax:
Practice Address - Street 1:5030 W STATE ROAD 46 STE 1018
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9247
Practice Address - Country:US
Practice Address - Phone:407-792-0226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty