Lake Mary Smiles, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LAKE MARY SMILES, PLLC

Doing business as

Lake Mary Smiles

Practice address

1511 International Pkwy
Lake Mary, FL 32746-4708

Phone

(407) 333-7393

NPI assigned

Mar 24, 2022

Last updated

Jun 3, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Peter Kelly

Title

Owner

Phone

(407) 333-7393

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lake Mary Smiles Doing business as

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin T Bonn, DMD

  • General Practice Dentistry
  • Lake Mary, FL
  • NPI 1467620690
  NPD (past)

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

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780444800000",
    "number": "1588314686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 CONWAY RD STE D",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328127354",
            "telephone_number": "407-432-6224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 INTERNATIONAL PKWY",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327464708",
            "telephone_number": "407-333-7393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MARY SMILES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-24",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-333-7393"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "DM19430",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "lakemarycosmeticedentist.com",
            "affiliation": "N",
            "endpointDescription": "larkmarycosmeticdentist.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "website",
            "address_1": "570 Rinehart Rd Ste 110",
            "city": "Lake Mary",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327464801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lake Mary Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lake Mary Surgery Center LLC
• Lake Mary Walk-in Medical Center
• Briana Lake
• Deoraj Ravi Lall, D.D.S.
• Lamadone Registry

• Dental Clinic/Center in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.