| Imagine Smiles Pllc | |
|
13205 Reams Rd Unit 164 Windermere FL 34786 | |
| (864) 906-6179 | |
| Not Available |
| Full Name | Imagine Smiles Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 13205 Reams Rd Unit 164, Windermere, Florida |
| Authorized Official Name and Position | Thao Latham (OWNER) |
| Authorized Official Contact | 8649066179 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Imagine Smiles Pllc 5259 Ariva Dr Apt 101 Lakeland FL 33812-4436 Ph: (864) 906-6179 | Imagine Smiles Pllc 13205 Reams Rd Unit 164 Windermere FL 34786 Ph: (864) 906-6179 |
| NPI Number | 1013598739 |
|---|---|
| Provider Enumeration Date | 04/15/2021 |
| Last Update Date | 04/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013598739 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Secondary |
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