| NPI | 1104908565 |
|---|---|
| Doing Business As | THE SMILE FAIRY DENTAL SPA |
| Entity Type | Organization |
| Authorized Contact | PATRICIA PRIMERO President 239-254-4480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL DN 12193) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2020-08-22 |