St. Cloud Smiles, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN18003 Issued in FL

Legal business name

ST. CLOUD SMILES, INC.

Practice address

2050 Old Hickory Tree Rd
Suite J
Saint Cloud, FL 34772-8926

Phone

(407) 556-3969

NPI assigned

Jun 8, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Jennifer Trang Van, D.M.D

Title

Owner

Phone

(954) 483-8184

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275955200000",
    "number": "1023338597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 OLD HICKORY TREE RD",
            "address_2": "SUITE J",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347728926",
            "telephone_number": "407-556-3969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 OLD HICKORY TREE RD",
            "address_2": "SUITE J",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347728926",
            "telephone_number": "407-556-3969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CLOUD SMILES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-08",
        "last_updated": "2010-06-08",
        "status": "A",
        "authorized_official_last_name": "VAN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "TRANG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-483-8184",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN18003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000333100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• St Cloud Physician Management LLC
• St Cloud Physician Management LLC
• St. Cloud Eye Care
• St. Cloud Eye Center, Inc
• St. Cloud SLC Opco, LLC
• St.Cloud Pharmacy & Wellness Center
• St.Cloud Pharmacy&Wellness Center
• St.Cloud Pharmacy&Wellness Center
• Marie Staley
• Derek S Stallard

• General Practice Dentistry in Saint Cloud, FL
• Providers in Saint Cloud, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.