NPIMap

Organization Active NPI

Smile Design Eagle Creek LLC

  • General Practice Dentistry
  • Naples, FL
National Provider Identifier
1265388987
Registry record updated Mar 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SMILE DESIGN EAGLE CREEK LLC
Practice address
12692 Tamiami TRL E
Naples, FL 34113-8431
Phone
(239) 417-6453
Fax
(239) 203-2355
NPI assigned
Mar 5, 2026
Organization subpart
Yes
Parent organization
SMILE DESIGN EAGLE CREEK LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2026

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

Authorized official

Name
Juli Renee Mietzner
Title
Credentialing Manager
Phone
(217) 540-5651

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

12692 Tamiami TRL E
Naples, FL 34113-8431

Mailing address

12692 Tamiami TRL E
Naples, FL 34113-8431
Phone (239) 417-6453

National Provider Directory

National Provider Directory
Part of
Smile Design Eagle Creek LLC

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1772668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772668800000",
    "number": "1265388987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12692 TAMIAMI TRL E",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341138431",
            "telephone_number": "239-417-6453",
            "fax_number": "239-203-2355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12692 TAMIAMI TRL E",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341138431",
            "telephone_number": "239-417-6453",
            "fax_number": "239-203-2355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE DESIGN EAGLE CREEK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SMILE DESIGN EAGLE CREEK LLC",
        "enumeration_date": "2026-03-05",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A",
        "authorized_official_last_name": "MIETZNER",
        "authorized_official_first_name": "JULI",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "217-540-5651"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naples, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; 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.