Provider Demographics
NPI:1942036264
Name:BESPOKE SMILES DENTISTRY, PA
Entity type:Organization
Organization Name:BESPOKE SMILES DENTISTRY, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GILI
Authorized Official - Middle Name:
Authorized Official - Last Name:LITWACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-342-0308
Mailing Address - Street 1:5770 WILES RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2156
Mailing Address - Country:US
Mailing Address - Phone:954-255-5166
Mailing Address - Fax:
Practice Address - Street 1:5770 WILES RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2156
Practice Address - Country:US
Practice Address - Phone:954-255-5166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental